Inflation

Baroness Noakes: asked Her Majesty's Government:
	Why public sector inflation is higher than overall inflation.

Lord McIntosh of Haringey: My Lords, because of the difficulties in measuring public sector output, the implied government consumption deflator from the national accounts may not necessarily give a good guide to genuine inflation in the public sector.

Baroness Noakes: My Lords, in thanking the noble Lord for that reply, I would like to wish him a very happy birthday.

Noble Lords: Hear, hear!

Baroness Noakes: My Lords, I would not like to spoil his birthday, but . . .
	I ask the noble Lord to consider the charts on page 224 of the Red Book, as I know that he will be familiar with them. The charts show that public sector employment is rising sharply but private sector employment is flat-lining. They show that private sector pay increases are rising at a much slower rate than public sector pay increases. Does the Minister agree that that is a classic recipe for yet more tax increases?

Lord McIntosh of Haringey: My Lords, if the noble Baroness, Lady Noakes, wishes to say to the 9,400 additional teachers who have been employed since 1997, the 26,000 additional school support staff, the 39,000 additional nurses, the 10,000 additional doctors, and the 5,000 additional consultants, all of whom contribute to the quality of our public services, that their services are not wanted—that is what she is implying by criticising the increase in public sector employment—she is at liberty to do so. I would rather not be in her shoes.

Lord Barnett: My Lords, leaving aside the solution to the world's inflation problems that the noble Baroness gave us, is the Minister aware—I am sure that he is—that, in his Budget speech, the Chancellor referred to the advantages of switching from the RPIX measure of inflation to the HICP measure used in Europe and in most, if not all, of the G7 countries, other than Japan? The Chancellor said that he would,
	"continue to examine the detailed implications".—[Official Report, Commons, 9/4/03; col. 273.]
	Can the Minister say when the implications will be reported?

Lord McIntosh of Haringey: My Lords, this is a rather theoretical debate that has gone on for many years, and I do not think that it will come to a rapid conclusion.
	With regard to the Question on the Order Paper, my noble friend Lord Barnett will know, as the Opposition appear not to know, that, for more than 20 years, public expenditure has been calculated at current prices and then deflated by a common deflator across the public and private sector.

Lord Newby: My Lords, does the Minister agree that one way to bring public sector wage levels into line with local market conditions is to introduce regional pay bargaining, which was mentioned by the Chancellor in the Budget speech? When will the Office for National Statistics publish the first regional inflation figures to enable such regional pay bargaining to be undertaken?

Lord McIntosh of Haringey: My Lords, that is an extremely constructive suggestion. The noble Lord, Lord Newby, is right to say that the Chancellor has raised the issue. There are difficulties, as well as possibilities. Some people will lose out.
	I do not know the answer to the noble Lord's question about the ONS, and I will have to write to him on that point.

Lord Campbell of Alloway: My Lords, does the noble Lord agree that his Answer to my noble friend was less than generous? The figures and information that he gave about expenditure in the public sector represent only half an explanation; the other half is the state that public services are in.

Lord McIntosh of Haringey: My Lords, I was encouraged by my noble friends to go on with the list, but I will not go on for as long as I could. I shall give an example of the achievement of 11 year-olds in our schools since 1997. The expected level of achievement in English has gone up from 63 per cent to 75 per cent since 1997; in maths, it has gone up from 67 per cent to 73 per cent since 1997. I could, at great length, give comparable results for the National Health Service.

Lord Saatchi: My Lords, I also wish the Minister many happy returns. Will he imagine, as his birthday treat, having the opportunity to listen in on a class being given by the Chancellor of the Exchequer, perhaps to the 11 year-olds he mentioned? The Chancellor would be saying something like, "My income is rising by 1.5 per cent a year; my spending is rising by 8 per cent a year; I will borrow the money to fill the hole; what will I get for my 8 per cent extra spending?" The answer would have to be, "Not much". As I am sure the Minister knows, three-quarters of the extra spending—the 8 per cent—is disappearing in public sector inflation, which is running at a level three times higher than inflation in the rest of the economy.

Lord McIntosh of Haringey: My Lords, my imagination is fertile, but it is not fertile enough to allow me to imagine the Chancellor uttering a farrago like that. I have already made it clear that the supposed distinction between public sector and private sector inflation is phoney—totally phoney. It has not been seriously used by any government, including governments of the noble Lord's persuasion, for more than 20 years.
	As to the question of what we get out of increased expenditure in the public services and the accusation that it is based on wage growth, since 1997 wage growth in the public sector has been, on average, 3.8 per cent a year, and, in the private sector, it has been 4.6 per cent a year. That gives no credibility to the suggestion that the money going on public services goes on wage inflation.
	The point is that these measures of inflation do not reflect quality. The same amount of extra spending on education could be achieved by doubling the incomes of teachers or by halving class sizes. In fact, it is achieved by the latter. They both give the same effect on so-called public sector inflation, but they do not reflect quality.

Baroness O'Cathain: My Lords, instead of trading statistics, as both sides have been doing across the Chamber, would not everyone be satisfied if the Minister were to say that he considered that the amount of money going into public services during the past 12 months had been properly spent and that we are obtaining value for money?

Lord McIntosh of Haringey: My Lords, I should have thought that subjective judgments of that sort ought to be based on statistics and facts. I do not prefer subjective judgments or perceptions to the facts.

Prison Population

Lord Campbell of Croy: asked Her Majesty's Government:
	Whether the number of offenders serving prison sentences in England and Wales has been increasing.

Lord Falconer of Thoroton: My Lords, the prison population on Friday 25th April 2003 was 72,890. This is a 4 per cent increase from the equivalent Friday one year ago. Of that total, the number of sentenced prisoners was 59,991 and the number of remand prisoners was 12,897.

Lord Campbell of Croy: My Lords, I thank the noble and learned Lord for his reply. Are the reports correct that the number of prison inmates is now the largest since records have been kept and that by 2006 it is forecast that more than 90,000 places in prison will be needed and fewer than 80,000 places will be available? If that is so, do the Government seek a reduction in custodial sentences?

Lord Falconer of Thoroton: My Lords, in response to the question on whether the number of inmates is now the highest since records began, I do not know when records began, but it is certainly the highest in living memory. As far as capacity is concerned, there is an on-going building programme under the 2000 and 2002 budget allocations. Two new prisons are being built. In addition, in the most recent Budget the Chancellor assigned further money to the building of more prisons.
	Do we think that fewer people should be sent to prison? It is for the judge to decide in each case whether custody is appropriate. Custody would normally be appropriate for serious offences, for dangerous and sexual offenders and for persistent offenders. As regards estimates of the prisoner population, as a rule we consider that it is unwise to speculate what the total may be in three or four years' time.

Lord Acton: My Lords, can my noble and learned friend say whether the number of women prisoners, which has increased enormously in recent years, is still increasing?

Lord Falconer of Thoroton: My Lords, there were 4,454 female prisoners last Friday, which is an increase of 2 per cent on the previous year. It rose more dramatically in the past so it is levelling off now, but it has risen during the past few years.

Lord Ackner: My Lords—

The Lord Bishop of Worcester: My Lords—

Noble Lords: Bishop!

Lord Williams of Mostyn: My Lords, I hear the call of the Lord—it is the Bishop!

The Lord Bishop of Worcester: My Lords, I am grateful to the noble and learned Lord the Leader of the House for identifying my wish to speak with the voice from above. I know that the Minister is as concerned as many of us about the effect of the rate of reoffending on prison numbers. I know that a great deal of attention is being given to that issue. Would he be prepared to look at the issue of confidentiality between the various agencies involved in resettlement? There is some concern that it would not be possible for the necessary level of co-operation to occur between and among the agencies concerned with resettlement. That would affect the ability of the resettlement programme to achieve the reduction in reoffending which, for example, the Social Exclusion Unit report—and I am sure that the noble and learned Lord himself—would wish. Will the Minister let it be known what, if any, obstacles to co-operation inter-agency confidentiality might present?

Lord Falconer of Thoroton: My Lords, yes, the Government would be prepared to look at that extremely important issue. If the employment service, the housing authorities, the social services, the prison authorities and the probation service can share information within the law, that would frequently help the resettlement prospects of the individual offender. One of the great difficulties is that the precise law is incredibly complex and there is no confidence among many agencies as to exactly when they can share information. It is an issue which needs to be considered. It has been highlighted in the Social Exclusion Unit report on how best to promote resettlement and it is something that we are considering.

Lord Ackner: My Lords, I have two short questions and that is why I sought to speak before the right reverend Prelate. First, what proportion of those in prison have been found guilty of offences within two years of leaving prison? Secondly, what is the average length of prison sentence now? Has it gone up, remained the same or gone down?

Lord Falconer of Thoroton: My Lords, in terms of the rate of reoffending within two years of release—let us assume 1998 is the date of release—for all prisoners, the reoffending rate is 59 per cent; for adult male prisoners, it is 55 per cent; for young male prisoners, it is 74 per cent; and for all female prisoners, it is 52 per cent. I cannot tell the noble and learned Lord off the top of my head what the average length of prison sentence is but I shall write to him.

Lord Dholakia: My Lords, will the Minister explain why, when the crime rate is falling, the prison population is rising? Does he know that we are now top of the league in terms of prison population in western Europe?
	The noble and learned Lord just gave the figures in respect of offenders. Eighty-four per cent of juvenile offenders are reconvicted within a period of two years. What advice can he offer to sentencers to ensure that intensive training, supervision and severance programmes are in place and that the probation service has sufficient resources to deal with these youngsters?

Lord Falconer of Thoroton: My Lords, first, as regards the relationship between the increasing number of people being held in prison and a reduction in the crime rate, I think that everyone is unclear about whether there is a link and, indeed, what it is that makes the crime rate rise or fall. However, it is not beyond the bounds of possibility that there is some connection between the two.
	Secondly, the noble Lord asked me what advice I would give to sentencers. Obviously I would advise that one of the most important roles played by sentencers is to meet the need to reduce the rate of reoffending. Seeking to reduce the rate of reoffending helps society as a whole. More resources must be provided for the probation service. Since 1997, the amount of money given to the service has risen in excess of 50 per cent because this is such an important issue.

Baroness Trumpington: My Lords, did the original figure quoted by the Minister include people being held on remand as opposed to convicted prisoners? If it did not, can he tell me how many people are being held on remand? They might end up not going to prison, although in the meantime they are occupying prison space.

Lord Falconer of Thoroton: My Lords, the figure did include those being held on remand. In my response, I broke down the figures. The total figure was 72,890. Sentenced prisoners—that is, those who have been convicted of a criminal offence—total 59,991. Those being held on remand—that is, awaiting trial—total 12,897.

Local Food Producers

Baroness Miller of Chilthorne Domer: asked Her Majesty's Government:
	What action they will take as a result of the report commissioned by the Department for Environment, Food and Rural Affairs, Local Food—A Snapshot of a Sector.

Lord McIntosh of Haringey: My Lords, this report was produced by a cross-departmental working group on local food and published three weeks ago, on 9th April. The group's aims were to consider the evidence relating to the impact of local food initiatives and the wider issues relating to local food so that government policy in this area could be developed. A number of government departments and agencies are considering what action they need to take in the light of the report. DEFRA will produce a policy paper on local food by the end of June.

Baroness Miller of Chilthorne Domer: My Lords, I thank the Minister for that reply. I am glad that, as a special birthday treat, the noble Lord's colleagues at DEFRA have given him an opportunity to answer my Question. I urge the Government to address this issue. Will the policies to be developed and subsequent actions taken be those that favour the small producers identified in the report as extremely important to the local food sector? Over the past five years, small producers have been disadvantaged by the implementation of almost every government policy covering issues concerning both food and farming.

Lord McIntosh of Haringey: My Lords, I am glad to be able to answer the Question, not least because during the briefing session officials were able to tell me where my nearest farmers' markets are here in London. As a devotee of such markets, I shall be taking advantage of that information.
	As regards small producers, while of course I cannot anticipate what we shall say in June, I could not conceive that any policies we may choose to adopt would not be in favour of small producers. That is the essence of the entire local food movement. I am sorry to hear that the noble Baroness, Lady Miller, thinks that government policies have discriminated against local food. That certainly is not the lesson I draw from the recently published report.

The Countess of Mar: My Lords, I declare an interest as a small producer of goats' cheese. I can reassure the Minister that despite all the regulations, provided that one works carefully with the environmental health officer, the trading standards office and the dairy inspection unit, one can get on very well. Provided that one obeys the rules, there are no problems. It is those who sail a little close to the wind who are suffering. They are in need of extra care from the regulating authorities.
	Given that we are considering food safety, does the noble Lord agree that very few small food producers in the farming sector are responsible for causing outbreaks of food poisoning and that these are much more likely to emanate from the catering sector?

Lord McIntosh of Haringey: My Lords, I am greatly reassured by the comments of the noble Countess with regard to small food producers, based on her own experience. I do not have evidence on where outbreaks of food poisoning originate as between producers and later stages in the food chain. However, my gut feeling—perhaps I should not use that expression—is that it is much more likely that such outbreaks would occur at later stages of the food chain rather than at the level of small producers.

Lord Jenkin of Roding: My Lords, does the report take account of the astonishing fact that a higher tax is paid on a lorry-load of tomatoes being transported from Suffolk to London than is paid for an entire jumbo jet full of tomatoes flown in from South Africa?

Lord McIntosh of Haringey: My Lords, airport taxes are a little wide of this Question. The issue of food miles, to which I believe the noble Lord is referring, is an important element considered in the report. A number of examples are given. This is a very practical report, citing real case histories of what has been successful. A reduction in food miles is good not only in terms of freshness of the produce, but also from a transport point of view.

Lord Mackie of Benshie: My Lords, how many small abattoirs have been closed down over the past five years? Given that they are enormously important to small producers trying to market their produce, what are the Government's plans for reversing the process of closure?

Lord McIntosh of Haringey: My Lords, I have not seen any reference to small abattoirs in the report, although I accept that the noble Lord, Lord Mackie, is right to make the point that if meat products are to be sold as local food, then the availability of local abattoirs is important. However, since no reference was made to local abattoirs, I do not have the statistics the noble Lord asks for. I shall have to write to him.

The Lord Bishop of Hereford: My Lords, can I help the Minister by saying that references to local abattoirs are made in the report and their importance is certainly emphasised.
	The potential for growth in the sale of local food and the need for infrastructure support are important points identified in the report. Also considered is the uncertainty in the minds of many consumers as regards exactly what constitutes a local product. Does "local" mean produce from a nearby farm, from the county or from within the UK? That question is exemplified in the quotation from Sir Peter Davis on page 12 of the report. Would the Government be prepared to consider the implementation of this report alongside the excellent recent report from the Commercial Farmers' Group, The Case for a UK Agriculture Industry and a National Food Security Policy? That is not a snappy title, but it is a good report. If that were done, the future of local food would be seen to form part of a renewed commitment to national food security, something which so many of us would welcome.

Lord McIntosh of Haringey: My Lords, that will teach me to read reports more carefully. I apologise to the noble Lord, Lord Mackie, and to the House.
	There is an issue reflected both in the report and in government thinking about whether we should seek to define what is meant by "local food". From what I have been reading, the first conclusion I draw is that it is not particularly helpful to enforce a definition. What is the difference between food that comes either 29 or 31 miles away from the place of sale? The second conclusion I draw, which fits in with the remarks of the right reverend Prelate, is that government policies must be supportive rather than prescriptive. That is because so much of what is successful in local food projects is due to the entrepreneurship of individuals and groups of people rather than government encouragement. We must avoid putting obstacles in the way, but it is people themselves who benefit from local food projects and they must constitute the driving force.

India and Pakistan

Lord Avebury: asked Her Majesty's Government:
	Whether, following the joint statement of 27th March by the United States Secretary of State and the Foreign Secretary on steps to reduce tension between India and Pakistan, they have any further initiatives in mind.

Baroness Amos: My Lords, the Government are continuing to work closely with our international partners, particularly the United States, to encourage further de-escalatory moves on both sides. It is important that both countries start and sustain a process aimed at building confidence, normalising bilateral relations and resolving outstanding differences, including Kashmir. As part of this effort, US Deputy Secretary of State Armitage will be visiting the region in early May. United Kingdom contact with the Indian and Pakistani Governments will continue through our high commissioners, as well as through planned contacts with senior visitors from the two countries in May and June.

Lord Avebury: My Lords, having broken the taboo, which has lasted for 30 years, that all matters of dispute between India and Pakistan are to be settled solely through bilateral negotiations under the Simla Agreement, will not the Government take this matter a stage further and agree that the poor relations between New Delhi and Islamabad constitute a threat to international peace that justifies consideration by the Security Council under chapter 7 of the charter? In this connection, will the Government consider proposing that UNMOGIP, the UN observer force on the boundary between Indian and Pakistani-held Kashmir—which is the longest-standing United Nations mission in history—should be asked to play a more active role, particularly in reporting on the shelling across the line of control and on which side is mainly responsible for it, so that the international community can see what are the facts?

Baroness Amos: My Lords, the noble Lord, Lord Avebury, is right. In terms of the relationship between India and Pakistan there has been a focus on this being an issue that the two countries have to resolve. Our position remains the same. A dialogue between India and Pakistan on these issues is very important. That is why the recent statement by India's Prime Minister is very helpful. The international community's role should be to support these efforts. That is why the visit of the Deputy Secretary of State will be important and why the visits here in May will be important. The UN is involved. I take the noble Lord's point about the monitoring of action across the line of control, a matter which he knows the international community takes very seriously. We saw an escalation in that violence last year. That violence has now de-escalated but we are keeping a close eye on the situation. If there is a further role for the United Nations, then of course there will be discussions in that forum.

Lord Ahmed: My Lords, is my noble friend aware that there is great concern that the impunity of the perpetrators of past and present human rights abuses in Kashmir continues without the full investigation of incidents? Would Her Majesty's Government support international investigation of massacres of civilians, including the massacre of Sikhs which took place on the eve of President Clinton's visit to India? Will Her Majesty's Government ask the Indian Government to allow Amnesty International and other international human rights organisations to visit Kashmir in order to investigate some of the excessive abuses of human rights? Would the Government support a special rapporteur on Kashmir such as there is on Sudan and other countries?

Baroness Amos: My Lords, my noble friend is well aware that we have condemned all violence associated with the differences between India and Pakistan, particularly in relation to Kashmir. Indeed, the statement recently made by my right honourable friend Jack Straw and Colin Powell while they were at Camp David was made in response to that violence, which they condemned. We shall continue to condemn that violence and we shall continue to talk to India and Pakistan about our concerns. The important first step has already been taken through the dialogue which has started on both sides. We hope that this will lead to the investigation of massacres that have taken place. It is very important that both sides should have a degree of confidence in the longer term.

Lord Howell of Guildford: My Lords, does the Minister agree that the Question gives the House an opportunity to join in the universal condemnation of the particularly horrific massacre at Nadimarg which took place towards the end of last March? While both sides have a duty to participate in seeking a peace process, does the Minister agree that, as regards the line of control, Pakistan has a particular responsibility to attempt to identify who committed this appalling atrocity and to bring them to justice? Will the Minister join with me in welcoming the fact that the American Secretary of State and the American Government, together with our own Secretary of State, are focusing their minds on this problem in a thoroughly constructive way which should bring benefits in the future?

Baroness Amos: My Lords, I have made our position absolutely clear in regard to the violence at the end of March. It was the trigger for the statement made by Secretary of State Colin Powell and my right honourable friend Jack Straw. I agree that we need to raise our serious concerns in our discussions with both sides. The noble Lord will know that we have been engaged in discussions with the Pakistani authorities about our concerns in regard to terrorism. We welcome the strong moves that they have made in that direction.

Lord Sandberg: My Lords, does the Minister agree that a little more effort by the British Government to try to get Pakistan back as a full member of the Commonwealth would be helpful, especially before President Musharraf pays a visit to this country in about six weeks' time?

Baroness Amos: My Lords, the noble Lord will know that the issue of Pakistan is one of the items on the agenda of the Commonwealth Ministerial Action Group, which is to meet in May. The group will make its own recommendations. It is important that we and the wider Commonwealth remain closely engaged with Pakistan, particularly through the transition process. We want to see the Commonwealth helping to sustain the process through technical and other kinds of assistance.

Lord Pearson of Rannoch: My Lords, is it true that when Pakistan was set up Kashmir was promised a plebiscite as to its future? If so, how do the Government regard the holding of such a plebiscite in Kashmir?

Baroness Amos: My Lords, it is not quite as straightforward as that. There are very different views about whether or not such a plebiscite was promised. We have always said that it is important that India and Pakistan engage in close dialogue on this issue. That dialogue process has started and we wish to support it. The visits which are due to take place in May will be an important part of that process. I shall be happy to send the noble Lord a lengthy background brief on this matter.

The Welfare State

Earl Russell: asked Her Majesty's Government:
	What policies the Prime Minister was announcing when he told the Financial Times of Monday 28th April that "what we have got to do is fundamentally to redraw the way the 1945 welfare state settlement is implemented".

Lord Macdonald of Tradeston: My Lords, the Government are proud of the achievements of the 1945 Labour Government in creating a welfare state in that age of austerity. Half a century on, we believe that deprivation and social injustice are best tackled by higher quality public services, implemented in line with four principles of public sector reform; namely, by the delivery of national standards of service through clear frameworks of accountability; by devolving and delegating to the front line; by promoting greater flexibility to respond to local needs; and by offering more choice to the users of public services.

Earl Russell: My Lords, I asked the Question because I do not understand what the Prime Minister means. Can the Minister explain further what the four principles mean in practice? Can he give any examples of measures which might illustrate them in implementation?

Lord Macdonald of Tradeston: My Lords, I recommend to the noble Earl the Fabian Society pamphlet of last September in which the Prime Minister explained why the reform of public services is the route to social justice. The first chapter is entitled "Beyond the 1945 Settlement". The first principle speaks to a problem that we have seen for half a century—that is, that the poorest sections of our society receive the poorest public services. We therefore have a radical and challenging aim of trying to create national standards of quality across the whole country. That will be best supported by the devolution of more authority and budgets to the front line; by greater flexibility for people on the front line to make the kind of decisions that offer a much more personalised service than people would have been able to have, or even look for, in 1945; and, of course, by building greater choice across areas such as the National Health Service. I cannot go into greater detail in my response, but much of the information is contained in the pamphlet, which I will happily make available to the noble Earl.

Lord Renton: My Lords, as I was elected to another place in 1945 and well recollect what happened during the years that followed, may I remind the Minister—because it does not seem clear from his statement—that the then Conservative opposition voted in favour of the National Insurance Act and another one dealing with industrial injuries insurance, which have stood the test of time very well and been amended from time to time? But the Conservative government and the National Liberals, of whom I was then one, voted against the National Health Service Act, and that part of the reforms has never succeeded as well as people hoped. Will the Government please concentrate now on getting that right?

Lord Macdonald of Tradeston: My Lords, I say again that we on this side of the House are intensely proud of what that 1945 Labour government achieved with regard to the creation of the National Health Service. I accept that there have been other areas of progressive legislation—one thinks of the Old Age Pensions Act 1908 and the National Insurance Act 1911 from the Liberals. Such examples come less readily to mind when I think of the Conservative Party's contribution in this area.
	We believe that the core values of fairness and opportunity for all that this Government promote are predicated on increased prosperity, because that prosperity allows us to make public investment on the scale that the Chancellor has announced in recent years, with an extra £63 billion going into public sector investment over the next few years. But we have made it clear that that kind of unparalleled investment should be linked to reform.

Lord Haskel: My Lords, does my noble friend agree that the Prime Minister is on record as saying that the values which underpin the 1945 settlement are to be maintained? It is the implementation which is to be altered, according to the circumstances which apply today.

Lord Macdonald of Tradeston: My Lords, my noble friend makes an important point. Those values of fairness, support and opportunity are enduring, but times obviously have changed radically since 1945. In the post-war era, after the arbitrariness of provision in pre-war times, people were therefore understandably very grateful for the state's ability to provide support to a sometimes very basic standard on a more universal basis, with access free at the point of use. We wish to make sure that we defend universal provision and access free at the point of use, but we want also to ensure, given all the changes that there have been in the past half-century, that we can offer more personalised services to people using our public sector and that we work with increased investment, more flexible labour forces and the new technologies to deliver that.

Lord Sutherland of Houndwood: My Lords, may I draw to the Minister's attention one particular aspect of the welfare state which could reasonably be fundamentally reconsidered at this stage—the way in which funds are made available for care of the elderly? Currently they are through two separate streams, the Department of Health and social security. This is not good from the point of view of the individual in need of care, nor is it an efficient way to use public money in facing up to a major issue.

Lord Macdonald of Tradeston: My Lords, I will leave the detail of the response to another Minister at another time. In general terms, I take the point that much of our delivery is complicated by red tape. Indeed, our attempts to deliver cross-cutting services can at times be in danger of creating more demands for audited information, and so on. We are therefore intent on trying to reduce the burden of red tape and of poor regulation, and I am delighted that in addition to all the work that the Prime Minister has put into this area, the Chancellor, in his Budget, said that the reform of regulation—the reduction of red tape—is one of the priorities that he will be imposing on departments.

Business of the House: Debates this Day

Lord Williams of Mostyn: My Lords, I beg to move the Motion standing in my name on the Order Paper.
	Moved, That the debates on the Motions in the names of the Lord Morris of Manchester and the Lord Pendry set down for today shall each be limited to two and a half hours.—(Lord Williams of Mostyn.)

On Question, Motion agreed to.

Disabled People

Lord Morris of Manchester: rose to call attention to initiatives to enhance the well-being and status of people with disabilities in the context of the European Year of Disabled People and the Charter for the New Millennium for disabled people worldwide; and to move for Papers.
	My Lords,
	"I wept because I had no shoes",
	said the poor orphan—
	"until I saw a boy who had no feet".
	This debate is about people with no limbs at all; others who are both blind and prelingually deaf; and those trying to cope with often devastating effects of chronic mental ill-health or severe learning difficulties, among Britain's 8.6 million disabled people.
	I am delighted the debate has brought together so many specialists in this policy area. Others would be with us if they could have been, including my noble friends Lord Callaghan and Lord Healey, to whom I shall refer again as I proceed. Among them, too, is my noble friend Lord Jones, who worked with me in the service of disabled people as a fellow Minister in the 1970s, and whose friendship I value deeply.
	I am especially glad that my good and noble friend Lord Ashley is here. We have been close friends and parliamentary colleagues for 37 years now, and his contribution to improving the quality of life of disabled people is immeasurable.
	The Motion calls attention to the European Year of Disabled People (EYDP) and the Charter for the New Millennium, because it is in the context of their objectives that initiatives here will ultimately be assessed. Thus I want briefly to summarise their aims. In the case of the charter, I do so having chaired the World Planning Group appointed by Rehabilitation International (RI) to draft the document. RI is the co-ordinating body for disability organisations in over 100 countries. Its affiliates in Britain include Rehab UK, RADAR and the Disability Rights Commission. The European Year's website states that its,
	"objective is to drive progress towards achieving equal rights for disabled people",
	and that activities to promote EYDP—launched in Athens three months ago—would be decided and organised by the disability community in each country.
	The statement of objectives stresses the multiple discrimination facing the EU's 37 million disabled people, who are two to three times more likely to be unemployed than non-disabled people and only half as likely to reach higher education. The Charter for the New Millennium, launched three years earlier here at the Palace of Westminster, at a service in the Chapel of St Mary Undercroft in December 1999, insists on,
	"the same human and civil rights for people with disabilities as for everyone else".
	It insists also that
	"disabled people's organisations must be empowered with the resources necessary to share responsibility in national planning for rehabilitation and independent living"
	and urges,
	"every nation to develop a comprehensive plan with clearly defined targets and timetables for implementing the aims set out in this Charter".
	Its principal aims call for a UN Convention on the Rights of Disabled People as a key strategy; action worldwide to protect millions of the world's poor from disabilities that are easily preventable at minimal cost; and international development programmes that mandatorily require accessibility for disabled people in all infrastructure projects.
	My noble friend Lady Hollis, who knows how glad I am that she is here, said when responding to EYDP for the Government on 11th February that they proposed,
	"to use the European Year to raise awareness of disability issues—especially rights and participation—throughout the United Kingdom".—[Official Report, 11/2/03; col. 553.]
	She listed the projects involving disabled people funded by the Government to mark EYDP. They outnumber those approved in any other European country and include a national disabled people's Parliament of 180 elected members, drawn from around Britain and reflecting both cultural diversity and the whole range of impairments.
	Of course, the Government's response to EYDP goes very much further than funding projects. It includes legislative changes to protect more than 1 million young people from discrimination in educational services; brings 7 million more jobs and 1 million more small employers under the Disability Discrimination Act (DDA); and strengthens the Act as it affects employment, access and the built environment. A new disability Bill, which it is hoped will address the Act's still major deficiencies in, among other areas, transport, housing and the defining of disability, has also been announced.
	Bob Niven, whom all of us respect for his achievements as the DRC's first chief executive, describes the Government's initiatives, taken together, as a,
	"fine way to mark the European Year".
	All that reflects well on Ministers but also on the high standing and influence of the All-Party Disability Group of MPs and Peers, chaired so ably by my noble friend Lord Ashley.
	As the author of the Civil Rights (Disabled Persons) Bill, which was systematically obstructed in another place from 1991 to 1995, I naturally very much welcome the Government's new initiatives, as I did the honouring of their pledge to legislate for a Disability Rights Commission (DRC). Without it, the DDA was a car without an engine and the achievements of Bert Massie, Bob Niven and their colleagues at the DRC could never have been attempted.
	Turning to the Charter for the New Millennium, again the Government's response was wholly positive. When it was presented to the Prime Minister at a ceremony in 10 Downing Street in July 2000, he stressed the Charter's importance to the world's over 600 million disabled people and said it would,
	"form the basis of a global consensus on priorities for at least a decade".
	As my friend the noble Baroness, Lady Darcy de Knayth, recalled in her debate on the Charter on 14th July 2000, it was as the architect in 1970 of the world's first wide-ranging legislation on disability—and as the first Minister for Disabled People—that I was invited in 1979 to open the UN General Assembly's debate which led to the International Year of Disabled People. At the same time, RI asked me to oversee the drafting of its Charter for the 1980s for disabled people worldwide, which became the basis for the UN Decade of Disabled People and informed its standard rules on disability.
	That was the background to my appointment to chair the World Planning Group that drafted the Charter for the New Millennium. Its membership included Chief Emeka Anyaoku, then Commonwealth Secretary-General; Deng Pufang, who chairs the China Disabled Persons Federation; Archbishop Desmond Tutu of South Africa; Shri D K Manavalan of India; Justin Dart of the US President's Committee on Employment of Disabled People; Anatole Ossadchik, Russia's Minister for Social Affairs; Prince Ra'ad Bin Zeid of Jordan; Professor Stephen Hawking; and Sir Harry Fang of Hong Kong, a former RI president.
	George Wilson, a senior officer of RI who chairs Rehab UK, had an important role, not least in promoting the Charter across the world, and Bert Massie was also helpfully involved.
	The Prime Minister told the House of Commons on 25th March 2002 (at col. 620W):
	"I welcomed Rehabilitation International's Charter for the Third Millennium in July 2000. In doing so, I said that I believed that it would form the basis of a global consensus on priorities for at least the next decade. This absolutely remains the Government's view".
	He was also able to report that at the UN General Assembly in November a resolution calling for an international convention on the rights and dignities of disabled people as envisaged in the Charter for the New Millenium was adopted.
	The Government's new legislative initiatives strongly reaffirm their backing both for the Charter and EYDP. Sadly however the long obstruction of the Civil Rights (Disabled Persons) Bill deprived this country of world leadership in disability rights legislation.
	It was in January 1979 that I appointed a committee of inquiry—the Committee on Restrictions against Disabled People—to examine the case for making discrimination against disabled people unlawful. It was chaired by Peter—now Sir Peter—Large and, had his report been acted upon when it was published in 1981, we would have been almost a decade ahead of the Americans with Disabilities Act. Instead, the United States acted on the CORAD report long before we did, and there was a 14-year delay before much weaker legislation was enacted here.
	Every statute on disability discrimination, all across the world, lineally descends from the CORAD report, and I pay warm tribute again today to Peter Large for performing the task I gave him so admirably. He was also involved in the setting up of Motability, which is celebrating its 25th anniversary, and that too is worthy of attention in this debate.
	Motability is a striking example to the world of what can be achieved when Ministers and voluntary agencies act together and in fellowship with industry and commerce to make life better for disabled people. The enterprise began long before the acronyms PFI and PPP were ever thought of but has done more for lasting social improvement than anything since created in their names.
	The political climate in which it was set up was starkly unpromising. Treasury control of public spending was at its most stringent and credit never more tightly squeezed. Yet the prerequisites for Motability's success included the creation of a mobility allowance; a doubling of its value in a year; and a £100 million relaxation of the credit squeeze to allow the clearing banks to back the scheme.
	Happily there were those, however, in and out of Parliament—and quintessentially, in Jim Callaghan, a Prime Minister—who were determined that it would succeed. Among them too were Denis Healey, then Chancellor of the Exchequer; Joel Barnett, then Chief Secretary to the Treasury; and Patrick Jenkin, then Opposition Front Bench Spokesman on Social Services. The key was the decision to phase out the invalid tricycle and phase in a mobility allowance that could be converted into a car. More than 1.5 million cars were provided in Motability's first 25 years and it was said, not only jocularly, that its vehicle fleet soon grew to rival that of the Chinese army.
	As Motability's founding Minister—and founder patron of the enterprise—I honour the memory of the late Lord Arnold Goodman, its first chairman, and the leadership of his successor, the noble Lord, Lord Sterling, Gerald Acher, CBE, Sir John Quinton, Noel Muddiman and all their colleagues over the years for their constancy in serving with such humanity those for whom it was conceived. With a team like that we may yet succeed in overtaking the Chinese army.
	This year the Government are spending £3.7 billion on outdoor mobility and overwhelmingly it is from this sum that Motability's funding derives. Moreover, in the last year before the mobility allowance was introduced, total spending on the old scheme—with which before 1974 governments of all persuasions were serenely satisfied—was counted in millions, not billions. Indeed, the private car allowance, which nearly twice as many entitled disabled people chose in preference to the trike, cost only £2 million.
	The mobility allowance is still unmatched in Europe or anywhere else and, without one, no other country has anything to compare with Motability. There remain problems, of course, but nothing to compare with those of the scheme that the mobility allowance replaced.
	Like everyone here, I have had raised with me issues of current concern to disabled people and their organisations. I shall refer briefly to just three. First, notwithstanding the Government's welcome abolition of benefit cuts in the first 52 weeks of hospitalisation, 1 per cent of patients—those most severely disabled—still face financial distress. This was put to me by the Association of Disabled Professionals and I shall be grateful if my noble friend Lady Hollis can arrange for the association to be consulted about the worrying cases raised in its submission.
	The second issue is the continuing concern among disabled people that the DRC could be merged in a single equality body. Again, it is severely disabled people who are most concerned, and I hope Ministers will find opportunities soon to discuss this with people such as Sir Peter Large, Kate Nash and Jane Campbell. I urge them also to pay close regard to the DRC's reaction to their consultation exercise and its comment that:
	"It would be ironic if, in EYDP of all years, the Government set a direction on equality institutions that in fact diminished the priority accorded to disability".
	The third issue is one raised in a letter from one of our colleagues. Acknowledging many "worthwhile improvements in benefits", he adds:
	"But handling of the various claims seems unnecessarily confusing. If you are not an expert it is difficult to distinguish where one overlaps another and I am sure it would be a blessing to a great many people if the system could be simplified".
	Here too I know that my noble friend will respond as helpfully as she can, since it is to this difficulty that disability organisations often trace the failure of many highly vulnerable people to claim their statutory entitlements.
	The European Year's aims and the Charter for the New Millennium alike seek to substitute hope for despair in the lives of disabled people, empowerment for dependence and social inclusion for segregation. They want from heads of government acts not of compassion but of enlightened self-interest and moral right. Both documents look forward to a world where citizens with disabilities are seen as giving as well as receiving; where their potential is understood and valued; where if years cannot be added to their lives, at least life can be added to their years; and where disabled people have an undoubted right to participate on equal terms with everyone else in the life and work of their communities.
	I began with a quote from a child and end with one from Chief Emeka Anyaoku about children. Speaking of his role in the drafting of the Charter, he writes:
	"I take pride most of all in the Charter's insistence that disabled children everywhere must now share the rights of all humanity to grow and learn, to work and create, to love and be loved".
	Let that be our spur in facing the still all too long unfinished agenda of unmet need.
	My Lords, I beg to move for Papers.

Lord Campbell of Croy: My Lords, I congratulate the noble Lord, Lord Morris of Manchester, on choosing this subject and referring not only to the European Year of Disabled People but also to the world-wide Charter for the New Millennium. Some 22 years ago, the International Year of Disabled People took place, sponsored by the United Nations. The noble Lord and I were both involved. I was asked to be chairman for Scotland. During that year, the chairman for England became seriously ill and then died. So I was asked also to take over his main engagements, and was able to do so where they fitted in with my being in London for Parliament. In the following year, 1982, the effects of the international year were assessed. It was estimated that in the United Kingdom more progress in public awareness of disabilities had been achieved in one year than in 10 ordinary years. The noble Lord has described events during that year. I hope that this European year will have similar success.
	I should again declare a personal interest having been disabled in the Second World War, a bullet going through my middle, among other things. I have been a war pensioner ever since, starting with more than a year in hospital and then spending time in a wheelchair. Further surgery over the years has put me on my feet with calliper and sticks, although of course I get more and more tottery.
	The noble Lord mentioned Motability. I think that that has been an excellent scheme. I remember when it was brought in. I supported the private enterprise involved. I myself benefited. Parked outside is one of the projects—a small Motability car specially adapted for me.
	In 1981, I drew attention especially to mental disability, including mental handicap and other disorders. Another campaigner—who I am glad to see is here and who no doubt will speak—was the noble Lord, Lord Rix, before he became a Member of this House. I met him during that international year. I think that mentally disabled people have benefited from the resulting improved understanding by the general public prompted by the international year.
	I have questions for the Government. First, what action are they planning to take to support initiatives in this field? Such action could be to enable more disabled people to live outside institutions, including hospitals, provided that the facilities they need are available to them and that they have access to helpers where necessary.
	I wish all success to this European Year of Disabled People and to those who are organising it.

Lord Ashley of Stoke: My Lords, I add my thanks to my noble friend Lord Morris for securing this debate. He has an outstanding record on a very wide range of disability issues, both as a Minister and as a Back Bencher. Listening to his very moving speech, I was reminded how easy it is to forget those early days when campaigning for disability was a very tough job. He had a marvellous record in those days and has had one ever since. I congratulate him.
	The European Year of Disabled People is an important landmark for Europe in general and the United Kingdom in particular. It marks the culmination of a decade of resolutions, policy statements, treaty articles and directives—all designed to bring disabled people in out of the cold, defend them from discrimination and provide access to jobs, buildings, education, and transport. A great deal has been achieved, and my noble friend has explained many of the developments. We are moving now into a new era in which people are increasingly setting these issues in the wider context of human rights and full citizenship rather than ad hoc advances. We need to go further along this route because it is a valuable key to a new world for disabled people.
	The European Year follows the European Union's welcome decision to make anti-discrimination a clear priority. Its policies on equality of opportunity for disabled people, on a barrier-free Europe for disabled people and in numerous directives on employment and other issues have been strong and farsighted. Now, however, it is up to the member states to implement those policies. There are some 38 million disabled people in Europe—about 15 per cent of the population—and some 25 per cent of people in the central and eastern European countries applying to join are disabled. The need for further advances is obvious as those disabled people are two or three times more likely to be unemployed than the non-disabled, and only half as many disabled as non-disabled are likely to receive higher education. In other words, in Europe as in Britain, the odds are stacked against them.
	If this special year is to result in significant progress, we need action as well as increasing awareness. Enduring achievements require a multi-pronged strategy by all countries, not just a few, and they should focus on anti-discrimination measures, removal of barriers, reduction of prejudice and the provision of new rights across the board—employment, housing, transport, education and training.
	Government initiatives in the United Kingdom have been very helpful to disabled people, especially the establishment of the Disability Rights Commission—referred to by my noble friend—the improvements to the Disability Discrimination Act, the Special Educational Needs and Disability Act, and the various pieces of legislation which have provided better opportunities for disabled people. I have praised the Government's efforts so far but my noble friend Lady Hollis would be extremely surprised, not to say shocked, if I did not add the word "but".

Baroness Hollis of Heigham: My Lords, I would be appalled.

Lord Ashley of Stoke: My Lords, my noble friend says that she would be appalled. The Government have many achievements to their credit such as those I mentioned a moment ago but they are inadequate because they are not comprehensive. I believe that one of the best contributions to the European Year of Disabled People that the Government can make is that when they deliver—I am sure that my noble friend is listening very carefully—their new disability Bill they make it a radical and comprehensive one instead of the piecemeal efforts seen so often in the past.
	I should like to offer help to my noble friend Lady Hollis. I always want to be helpful to her. The new government Bill should embrace all the contents of my Disability Discrimination (Amendment) Bill which we debated in the House in January last year.

Baroness Hollis of Heigham: My Lords, does my noble friend wish the Government to embrace the clauses that he withdrew as a result of debate in this House, for example, those associated with the Armed Forces?

Lord Ashley of Stoke: My Lords, I am grateful to my noble friend for that comment. I withdrew those clauses as a tactical ploy. The tactic now is to pursue all of them. We can easily outmanoeuvre the Government, especially in this House. When it comes to votes, the Government are in a minority. My noble friend will suffer for the comments she made but I forgive her just this once.
	As I said, the new government Bill should embrace all the contents of my Disability Discrimination (Amendment) Bill which we debated in the House in January last year. The Government will find many necessary provisions there: to include people with HIV in the DDA; to ensure that private clubs come under the remit of the DDA; to give the DRC powers which are not contained in the DDA to act for disabled people under the Human Rights Act; to bring all firms into the DDA; to give employment tribunals power to order reinstatement of employees who have suffered discrimination; to include all transport in the DDA; to forbid public authorities to discriminate against disabled people; to place a duty on the public sector to promote equality of opportunity for disabled people; to extend the duties in Part 3 of the DDA to landlords in particular; to extend the DDA questionnaire procedure, which applies to employment claims, to Part 3 of the DDA (goods, facilities and services); and to ensure that all discrimination claims under Part 3 of the DDA are commenced in an employment tribunal.
	In commending those suggestions to my noble friend I assure her that my Bill is easy to read, easy to follow and, given the political will, easy to implement.

Lord Addington: My Lords, does the noble Lord consider that corpsing in the House of Lords is a first for him and also that it is the first time he has managed to inspire this much mirth on this subject?

Lord Ashley of Stoke: My Lords, it is certainly a record which I do not claim with any great pride.
	The time is flying due to the diversions of my noble friend Lady Hollis. The Disability Rights Commission—which I think is a marvellous organisation—under Bert Massie and his staff works to ensure that businesses and disabled people have the information they need to meet their obligations and secure their rights under the DDA. The DRC has carried out absolutely splendid work.
	I turn finally to the problems associated with mental health. Discrimination and stigma remain all too common for people with mental health illnesses. Our own mental health laws are outdated and the Government's recent botched attempt to draft a mental health Bill rightly met with strong opposition, notably from the Mental Health Alliance, an alliance of disability charities, mental health practitioners and unions. The draft Bill introduces compulsory treatment in the community—a move that the alliance argues will lead to an increase, not a decrease, as the Government suggest, in compulsion.
	In addition, under the current Act, to detain a person for compulsory treatment, there must be treatment available to alleviate their condition. However, the draft Bill removes this requirement. While there is a requirement that the treatment is available, there is no requirement for the treatment to be of therapeutic value to the patient. Instead, the treatment can be provided in order to protect others against danger. I am in favour of protecting the public but not at the expense of ensuring that people who are mentally ill have the proper treatment. We should be able to achieve both aims; that is, protection for the public and helping people with mental illness. The proposed measure is ridiculous. The Mental Health Act should be about providing treatment for people's mental health. Public safety is a criminal justice matter and should not be dealt with in a health Bill. The Government are sending out the wrong signals by linking public safety and mental health. That will not protect but stigmatise, ultimately driving people away from seeking the treatment they require.
	There is a great deal more to be said on many of the issues we are discussing but I shall conclude now out of courtesy to those who have yet to speak. This Government and especially my noble friend Lady Hollis have a fine record on disability. I readily admit that. I pay tribute to them for the fine work they have done. However, we need to go much further. The Government's new Bill is profoundly important in terms of transforming help for disabled people. If the Government grasp the nettle, we shall be able to do more for disabled people in the future than we have ever done in all previous legislation. I ask my noble friend and the Government to think about making that radical transformation a reality using this European Year of Disabled People as the peg.

Lord Rix: My Lords, as president of Mencap, one of the country's biggest disability organisations, I welcome the initiative of the noble Lord, Lord Morris of Manchester, in drawing attention to this European Year of Disabled People. We should not need special years but until equal citizenship for disabled people is implemented as well as being acknowledged throughout Europe, we shall need special years.
	Sadly, people with a learning disability do not always enjoy equal status with other people with disabilities—even within the community of people with disabilities itself, although I think that that is changing, as has already been indicated by the noble Lord, Lord Campbell of Croy, who mentioned IYDP. I think that that is when the change began to take place.
	As eastern European countries come forward for EU membership, we become even more conscious of the marginalisation of disabled people in general and of people with learning disabilities in particular, and of the challenge to ensure that economic progress narrows rather than widens the gap between disabled and non-disabled people.
	Mencap has played a significant part in Europe generally, and in eastern Europe in particular, with Gail Stewardson, Mencap's European Officer, being very much to the fore. The three key themes of this work have been: empowering disabled people and family carers; sharing experience and expertise; and local solutions to local problems using local resources. Those same three themes characterise progress on services for people with a learning disability in this country where we share a surprisingly similar disability history with our continental neighbours.
	We have come a long way in the world of learning disability since our Down's Syndrome daughter was born nearly 52 years ago. The first improvements surfaced in 1971 with the White Paper, Better Services for the Mentally Handicapped and with the implementation of the Education (Handicapped Children) Act, which included children with severe learning disabilities in the education system for the very first time.
	It was in 1970 that the noble Lord, Lord Morris of Manchester, secured through a Private Member's Bill in another place the Chronically Sick and Disabled Persons Act. All these groundbreaking achievements—for they were achievements, believe me—came only a year or two after the population of the old "subnormality hospitals" had peaked with the appalling number of over 60,000 men, women and children still virtually incarcerated. Today, about 1,500 people with a learning disability continue to live in English hospitals, but in greatly changed circumstances, while those still alive from that peak figure of 60,000 have become our neighbours in the community.
	Then, 30 years on from that first White Paper, came the publication of Valuing People, a milestone in governmental attitudes towards the provision of services for people with a learning disability. The Government deserve great credit for this very different White Paper, which enshrines choice, rights, independence and inclusion—all of which could be summed up as treating people with a learning disability as equal citizens.
	The All-Wales strategy for people with a learning disability, published in 1983, attracted great interest across Europe and indeed all round the world. I trust that my Welsh friends will not accuse me of xenophobia if I say that I think the English White Paper has secured the same wide audience. Mencap is a founder member of the erstwhile International League of Societies for People with a Learning Disability, now the highly esteemed Inclusion International. That organisation's European arm in particular is keenly watching progress with implementing Valuing People, and interested parties in the about-to-be new member states are also very much aware of what we seek to do. If I might stray a little further afield, we hope that the White Paper's principles may inform work that we are endeavouring to do with our Arab colleagues in post-war Iraq.
	It is imperative therefore that we secure the White Paper's full and successful implementation, and I hope that your Lordships will understand why I want to take the opportunity of offering a few helpful comments and criticisms.
	I start by welcoming the first government annual report to Parliament on Valuing People, which was published in April. An accessible White Paper followed by an accessible report on its implementation is quite something. The report highlights the fact that much has been done, and there are certainly areas where we can be satisfied. We have made great progress in the inclusion of people with a learning disability in the planning and implementation processes at all levels. That is particularly true at task force level. However, the picture is more mixed around the country in the local partnership boards. Mencap's recent report highlighted the reality of patchy local development.
	Perhaps the concept of putting the aspirations of people with a learning disability at the centre of the planning and implementation process is just too challenging. On the other hand, there is encouragement, as some areas have grasped the nettle, confronted the difficult issues, and are beginning to make it work.
	I am concerned, however, that learning disability is not one of the key priorities for government departments, health authorities and trusts, or local authorities. The amount of money available is inadequate. Changes in funding arrangements mean that an overall picture is simply not available, but the experience of shortfalls and cutbacks is in sharp contrast to the picture painted by the Department of Health. That contrast is not, of course, entirely new. Nor is my expression of concern about funding shortfalls, or my feeling that government replies fall a little short of total reassurance.
	One of the weaknesses of Valuing People is that very little extra money has been provided to implement it. Without adequate funding, many of the high ideals will continue to be frustrated. A central plank of the White Paper is "person-centred planning"—a horrible phrase, but that is the one used—which is intended to give people real choices in their lives. But choice means more opportunities and support, of better quality, for more people, and there is inevitably more cost. The common experience across Europe has been that better things can be done with the same amount of money, but that better things still can be done with greater amounts of money.
	I wish that the Government would lift the curtain of the dark a little and provide us with the actual cost of fully implementing Valuing People. I also return to an old warhorse of mine. Why cannot the Government agree that adequate funds should be earmarked for local councils to implement the learning disability programme fully, without having to reduce services in other areas? I have asked that question many times in relation to various aspects of government funding, and the answer has always been a lemon. Surely by now the lemon has been squeezed dry. If so—if I may mix my drinks and my metaphors—could the Government not offer a little more milk of human kindness instead?
	In applauding the Government's concern for outcomes, I also hope that they will offer an effective framework of outcome measures by which to monitor the progress in implementing Valuing People, otherwise its aspirations could be lost. Unless the range of government departments concerned develops and monitors clear targets, aspirations will become expirations. I am sure that the French have an appropriate term to describe big dreams and modest reality.
	People with a learning disability are still excluded from many mainstream services including housing, which is one area where there is a need for not only new and imaginative thinking, but simple growth in the services available. I hear regularly from elderly parents who still have sons and daughters with a learning disability living with them, and are desperate to know what will happen when they have gone. The needs of those elderly parents are highlighted in Valuing People, but there is little evidence as yet of plans to help. In Mencap's survey of 150 local authorities last year, we found that only half of the local authorities knew the numbers of people living with older parents aged 70 or over. Worse still, only one in four local authorities has planned alternative housing for them.
	Probably the saddest feature of European learning disability history is the treatment of those described as irrecoverable, untreatable and ineducable—people with profound and multiple learning disabilities, and often associated sensory and physical disabilities. Probably the greatest achievement, in some parts of Europe, has been the discovery and implementation of ways to bring the most severely disabled people into the mainstream of services and opportunities. Probably the biggest gap in the White Paper is the relative lack of attention to that group, exacerbated by the tendency to lump it in with a very diverse group of people with extra problems.
	Learning disability will not be treated as a priority in England or the rest of Europe, unless European governments and the community as a whole give learning disability the higher importance that it deserves. Having a dream is great, but the dream begins to lose its attractions if it remains forever unfulfilled.
	An elderly lady from Surrey and a young woman from Romania with a learning disability provide an abiding image for the European Year of Disabled People. The lady and her late husband invested huge energy and money in Romania and befriended the young woman. The young woman once lived in a Romanian institution, suffered greatly there, and has had difficult times since. Her teeth have been kicked out; she was mugged on the way home from work. However, she travelled to Brussels to address European leaders, and with support moved from being someone put away and abused, to someone listened to and respected. That picture speaks for the new way forward for the new Europe in this year of disabled people.

Lord Carter: My Lords, like other noble Lords I begin by congratulating my noble friend Lord Morris of Manchester on obtaining this debate to mark the European Year of Disabled People.
	On a personal note, perhaps I should say at the outset that it is something of a culture shock for me to be speaking from the government Back Benches on disability, after 10 years on the Opposition Front Bench berating the Conservative government on the subject. Then I had five years in government when I was not able to speak on the subject in the Chamber. What I said in government is another matter, of course. For a number of those years in opposition, I shared the Front-Bench brief with my noble friend Lady Hollis of Heigham, who will reply to the debate. I apologise in advance to her if I lapse into berating mode—old habits die hard.
	I wondered how best to frame my contribution, but last week, in the Recess, I was sorting out some papers in my study at home. Purely by chance, I came across a pamphlet produced in 1980. It is entitled New Horizons for the Disabled. It was produced by the Co-operative Party and the author was one right honourable Alfred Morris MA, MP. The foreword is by the right honourable James Callaghan MP. The pamphlet sets out an agenda for action to help disabled people. It might be useful to see how we have fared in the past 23 years in helping disabled people by considering that agenda for action.
	The first few words of the pamphlet are as true now as they were then. It states,
	"many people still saw the disabled as objects of pity and occasional charity, to be looked after because of their disabilities rather than encouraged to make the most of their abilities".
	The pamphlet estimated that there were then 3.5 million disabled people. The figure now is estimated to be nearer 8 million, plus the involvement of those who have a disabled family member. The exact figures are hard to come by, but it has been estimated that one in four of the population is involved, directly or indirectly and in one way or another, with disability.
	We have certainly made some progress when we consider, for example, the demands for accessibility that were made in the pamphlet in 1980. They related to access to shops. The pamphlet stated:
	"A fully accessible retail store should have: . . . Easy access from car-parking facilities . . . No steps leading to the main entrance from the street . . . A simple entrance arrangement with wide doors that will stay open long enough to allow a person who is slow moving or in a wheelchair to enter safely and comfortably . . . Aisles wide enough for wheelchair customers, gripping rails in all toilets and locks that can be operated by people with arthritic hands or a weak grasp . . . Resting points for frail, elderly and disabled people who soon get tired".
	That is just as true now as it was then.
	When we turn to the vital matter of employment, I cannot do better than to quote from letters written more than 20 years ago to the working party of the noble Earl, Lord Snowdon, on the integration of disabled people. It was stated that:
	"Work is so important, not only to provide an income, but also to keep one in circulation in the wider world, still as an integral part of the community.
	"The real secret behind a disabled person living a happy and useful life is simply to work.
	"So far as employment is concerned, my friends feel that there is more discrimination against the handicapped than against coloured people".
	In comparison, the most recent figures indicate that 75 per cent of blind and visually impaired people of working age are unemployed. That compares with the national average of about 3 per cent. Yet, more than 20 years ago, research studies showed that disabled people were reliable, loyal, conscientious and productive workers. They had less time off for sickness than non-disabled people. That is just as true today.
	There are many obstacles still to overcome. An article in the Guardian of 4th April highlighted the practical problems that are the everyday experience of disabled people and those who care for them. The article was written by a mother who could not book tickets for the National Film Theatre because her 10 year-old daughter was a wheelchair user and therefore a fire hazard. The new trick now is to use health and safety regulations as a way to get around the Disability Discrimination Act. The article also mentioned a man who was refused membership of a gym because his diabetes posed a risk to safety, as was a person with a visual impairment. The same girl who was denied entry to the National Film Theatre was also denied swimming lessons at school, again on grounds of safety. I am glad to say that the National Film Theatre and the swimming pool have altered their policies and the young lady can now attend both. But how many disabled people have a relative who can write an article for the Guardian?
	Only today, an excellent report, which your Lordships may have seen, was published by Mencap. It is called Arts for All? and it is about the access to arts facilities in London for disabled people. The introduction to the report says:
	"The project and report focuses on the experiences of families on their unannounced visits to popular family attractions in London.
	"Some key findings include: . . . The attitude of some staff and members of the general public makes parents reluctant to plan a family day out . . . Access arrangements are complicated and inflexible. There is also a lack of seating and rest areas . . . Public transport presents many difficulties. Some stations do not have any suitable lifts, escalators and waiting areas . . . Lack of accessible toilets in venues. Most are shared with baby changing facilities and are unsuitable".
	I turn to the question of employment. I have over the years visited a number of organisations connected with disability, and have always asked them the same question: "How many disabled people do you employ?". A recent survey by the publication Disability Now gave the figures for 14 major nationally known disability organisations. The percentage of staff who were disabled ranged from 100 per cent to nil. Seven of the 14 organisations employed less than 10 per cent disabled people, and among those seven—they are well-known organisations—out of a total staff of 20,119, the number of disabled employees was 672. The parable of the beam and the mote springs to mind.
	We have of course made progress. There was the Disability Discrimination Act, which was passed by the Conservative government. Here I pay full tribute to Mr William Hague, the Minister concerned, who I know overcame much opposition within that government to get that Act on to the statute book. It was not all that we wanted but it was a start. Then we had the Act passed by this Government, which is coming into force with the backing of the Disability Rights Commission.
	Those Acts mark real progress in principle and practice but the practical problems of everyday living, of getting to and from work, of the work environment and of going to entertainment are the still the problems that disabled people meet and have to overcome every day of their lives. We have heard that the Government propose to publish in the summer a draft disability Bill. In terms of pre-legislative scrutiny, that Bill appears to be an ideal candidate for scrutiny by a Joint Select Committee of both Houses.
	My daughter is blind with substantial hearing loss. I asked her for two practical examples of the problems that she faces. The first was the simple problem of reading her personal post. She either has to take it to work and have it read by her reader or a fellow employee, although items in the post could be extremely private, or she must wait until a family member is available. She is the first to admit that there is no easy answer to that problem. Her second point was that if "Mind the gap" can be announced on Tube trains, why cannot the name of the station be announced? Before I could point out that "Mind the gap" is a standard recorded announcement, she said that the only way in which she recognised Victoria was because the voice that says, "Mind the gap" is different. Such announcements are made on certain lines but it would be an enormous help for visually impaired people if that were universal. I used those two practical examples deliberately because in all of the proper rhetoric about the European Year of Disabled People is the real, day-to-day life experience of disabled people, and that should be at the forefront of our concerns.
	I began with a quotation from the pamphlet of the noble Lord, Lord Morris, and I shall conclude with a further quotation, which is an admirable statement of the principles and practice of the Motion and it well stands the test of time. The noble Lord wrote:
	"we must seek a society in which there is a genuine respect for the handicapped; where understanding is unostentatious and sincere; where if years cannot be added to the lives of the very severely handicapped, at least life can be added to their years; where needs come before means; where the mobility of disabled people is restricted only by the bounds of technical progress and discovery; where the handicapped have a fundamental right to participate in industry and society according to ability; where socially preventable distress is unknown; and where no [one] has cause to feel ill-at-ease because of his [or her] disability".

Lord Corbett of Castle Vale: My Lords, I join the warm congratulations to my noble friend Lord Morris of Manchester on securing this topical and important debate. I declare an interest as a director of Rehab UK, which is so ably chaired by the dedicated and determined Mr George Wilson, CBE, to whom my noble friend Lord Morris referred earlier.
	This debate is topical because, as we have been told, this is the European International Year of People with Disabilities. It puts a new focus on the need for governments to ensure that, in the words of Rehabilitation International's charter:
	"In the Third Millennium, it must become the goal of all nations to evolve societies that protect the rights of people with disabilities by supporting their full empowerment and inclusion in all aspects of life".
	I want to thank the Government for topping up funding of £0.5 million from the European Union by £2 million to make possible in the United Kingdom more projects involving people with disabilities than in any other EU state. I also warmly congratulate the Disability Rights Commission on its central co-ordinating role in the European Year in the UK, not least in organising with others an international congress of young people with disabilities in Swansea.
	I want to confine my comments to rehabilitation and I immediately welcome the two-year pilots in six areas started earlier this month to examine barriers preventing people returning to work after sickness absence and how to overcome them. Some of your Lordships may wonder, as I certainly did, why it took any government so long to think that that was worth considering. But there we go; we have it now. I hope that some of the comments that I shall make about rehabilitation may assist in the organisation of those pilots.
	The Select Committee on Health in another place reported in March 2001:
	"Head injury is the foremost cause of death and disability in young people . . . There is a growing population of head-injured people in this country, as improved medical techniques have led to many head-injured people . . . living into old age, with a normal life expectancy".
	It is, in fact, estimated that around 100,000 people a year are affected by problems created by brain injury. Many are because of road accidents; others are because of accidents at home or at work; and yet others result from violent criminal assault.
	Most of those involved in head injuries are men aged between 19 and 30. Perhaps what is not properly understood is that about six in every 10 brain-injury victims are capable of being trained to return to paid work. That is what Rehab UK does in its centres around the country. At a cost of about £12,000 to £13,000 for a one-year course, a person with brain injury can be helped to return to work. That is enough in itself in terms of independence, dignity and self-respect; in cold cash terms, it saves around £300,000 per person in benefits over a working life and turns those individuals from tax takers into tax payers.
	In his introduction to the booklet, Pathways to Work: Helping People into Employment, Secretary of State Andrew Smith wrote:
	"I believe that everyone who wants to work has the right to do so".
	That is a very commendable statement and we can all agree with it. But if that is to be achieved and if the Government really mean that, then they need to make the sustained investment to make it a reality.
	I have to say to my noble friend who is to reply to the debate that it may be the present reality but it was unhelpful and got in the way of Secretary Smith's good words when my noble friend said bluntly on 11th February this year in response to a question about the need for extra funding for Rehab UK's Tyne and Wear centre:
	"I regret that my department cannot extend or increase its funding without taking it away from other forms of disability".—[Official Report, 11/2/03; col. 555.]
	As I said, that may be the present reality but it gets nowhere near to meeting the present and growing need. In my view, that is the nub of the problem. There is no single government department with responsibility for ensuring the rehabilitation of those assessed after brain injury as being capable of returning to work—I repeat: no single government department.
	Instead of opening a chain of regional assessment and training centres, for which there is need, Rehab UK has had to close its Manchester centre, not because of a lack of demand and not because of any doubt about the outcomes achieved at that and other centres but because of the inability of a disparate group of potential funders to find ways to work together and to do the things that are needed to be done at the same time. Perhaps I may say that it is bad enough when they do because normally that is simply on a one-year basis and, as the calendar changes around the circuit, those employed by Rehab UK must attend again. I believe that that is entirely the wrong way to mark the European International Year of People with Disabilities.
	I acknowledge that the funding position over the Tyne and Wear Rehab centre has improved in the short-term and I am grateful for that. But that is not the whole or the proper solution. As I said to your Lordships, Rehab UK now has to knock on the doors of the Department of Health, the Department for Work and Pensions, the Department for Education and Skills, local authority social services departments, primary healthcare trusts and often other parts of local authority structures.
	That will never fulfil Secretary Smith's ambition for the right of everyone who wants to work to be able to do so; it will never get anywhere near to meeting the needs of people with brain injury; and it will never properly deal with a problem to which there is a known solution if government can better get their act together over this important area.
	Personally, I do not believe that this is primarily a responsibility for the Department of Health because it is at the point where the hospitals and specialist units have done the best they can with an individual that an assessment can then be made about the potential of that individual to respond to training as a way back into work. It is possible that the Department for Education and Skills is the most appropriate department to deal with the issue. However, frankly I do not care which government department it is. The plea that I make to my noble friend on the Front Bench is that we need to have a single lead department to take responsibility for this important area.
	In my view, those six in 10 people with brain injuries who are capable of being helped back to work demand and deserve nothing less. They will be denied the help they need and the economy will lose their skills and talents, of which we have need, unless the Government can better organise investment in their rehabilitation. The European International Year of People with Disabilities is a good time to pledge that that will now be done, and I very much hope that my noble friend will be able to make such a pledge when she replies to the debate.

Baroness Howarth of Breckland: My Lords, I join other noble Lords in congratulating the noble Lord, Lord Morris, on initiating this important debate and thank him for giving me the opportunity to celebrate the initiatives of John Grooms, a charity with which I have been associated for the past 15 years. The noble Lord, Lord Morris, took a very strategic overview as a campaigner. For many years I have been involved as a director of social services and in John Grooms as someone delivering services. Therefore, it is from that point of view that I want to address my remarks today.
	There is, indeed, much to celebrate in the steady developments and improvements in the services and care available to enable people with disabilities to live rich and independent lives. Not only has environmental access improved beyond recognition but the greater integration of people with disabling conditions into our communities is totally different from the kind of segregation many suffered even a decade ago. We now have clear standards for care, and I declare an interest as the vice chair of the National Care Standards Commission. Those will ensure that not only residential care but also domiciliary and other services will undergo inspection, which must include consultation and partnership with users of services.
	The charity John Grooms, an organisation delivering residential care, day care, domiciliary help and holidays to severely disabled people, is committed to that partnership. Community care is vital and in addition to our residential establishments we have been involved in supporting some exciting initiatives to enable people to live in their own homes. But today I want to focus on what is often seen as the less attractive option of residential care because for many severely handicapped people that is the only alternative they have to being in hospitals or other institutions. That has changed beyond all recognition since I have been on the board of John Grooms.
	When I joined the charity, its flagship was a large, village-type, residential home at Edgware, which some noble Lords may remember. It was, indeed, called The Cripplage. It came out of the 19th century and was certainly not fit for purpose in the rapidly-approaching new millennium. The board decided to sell the site and to use the funds to build two state-of-the-art homes in North London that would meet our aspirations to be at the forefront of the kind of care that would give maximum independence to those least able to care for themselves but with the desire to do so.
	These homes were added to the other establishments that we run including an older but similar establishment in Norwich, John Grooms Court. All these homes have large, self-contained rooms with en suite shower rooms, a kitchen facility and access to communal dining rooms and leisure rooms. Noble Lords would not, I am sure, expect me to be giving a description for no reason. I now want to turn to the difficulties that we are beginning to face.
	Most of our residents require constant care and each of our homes is registered with the commission and subject to inspection. In most aspects, the establishments are far above the national minimum standards. We are proud of this and grateful for standards. Whether we will be able to continue this high level of provision is now under threat in a way we could never have anticipated and is almost beyond belief as we celebrate the good work undertaken by so many organisations in the present day.
	I turn to my example. The issue concerns registered residential and nursing homes and the matter of disaggregation of council tax in that the council tax legislation provides for "single dwellings" to be treated as a number of dwellings where there are one or more "self-contained" units within, and for each of these to have a separate tax band. The test is a physical one and appears to be that the inside doors have a lock and separate kitchen facilities, something to which we would aspire for all our disabled people, however disabled.
	In a recent hearing involving the RNIB, the Inland Revenue agreed to withdraw the disaggregation notice in relation to bed-sit flats on the basis that they were so small as to prevent use without the communal living space. Four larger flats are still the subject of consideration. At a tribunal in Norwich the same arguments were put in relation to John Grooms Court, which provides bed-sits for wheelchair users, who also require considerable personal care. The valuation officer argued that additional space provided and needed for a wheelchair user is irrelevant. The fact that the bed-sits are larger means that they are capable of use as a separate dwelling even though they are clearly not used as that.
	I realise that this begins to sound like Alice's Adventures in Wonderland. The good news is that after considerable deliberation the tribunal agreed and found in our favour. However, that was not before the association had incurred considerable costs, funds raised by the charity which would otherwise have been spent on service users in the establishments. The action has reduced what little reserves we had to plan for new homes like the one we hope to build at Southend. The demand for places in our homes is continuous. We do not run a waiting list as any vacancy is immediately filled. There is certainly a demand.
	Had the decision at Norwich tribunal gone against the charity, the additional costs to John Grooms could have been as much as £100,000 per year, which we would have had to pass on to local authorities or have every resident make claims for housing benefit—as for supported living—when most of them would be incapable of doing so themselves or to stop further development in capacity or quality.
	But on to Through the Looking-Glass and why in this debate I raise the issue and ask for the Minister's response to the situation when we are considering here the provision of the best facilities to give quality of life to people with severe disabilities. After the tribunal found in our favour, the Inland Revenue appealed against the decision in order to get the High Court to clarify, as stated by the legal adviser,
	"what is poorly drafted legislation".
	There is, indeed, a lesson for us as we look towards a new Bill in ensuring that any new legislation is clearly written. The effect of this in policy terms is that if we were to provide small rooms with shared facilities we would not have the problem. So, dormitories with no facilities are okay.
	We understand that the valuation officer would not want to have flats behind care home facades but we are a registered, inspected care home and have to meet the criteria for personal care otherwise the provision would simply become supported living. I do not believe that the Government would ever have intended that organisations such as John Grooms and the RNIB should be faced with the costs of clarifying legislation or that this situation should have arisen at all. Just getting on with the job of running the services, training and recruiting good staff, continually ensuring quality care and developing provision to meet future needs is enough without this to take away energy and resources.
	John Grooms is determined to continue to meet the future with the best provision possible and, with the support of the TSB Foundation, has recently undertaken a review of future needs. With the support of the All-Party Parliamentary Group on Disability it will be launched here in Parliament on 3rd June. I had the privilege of chairing the review. The most encouraging finding was that the disabled people we work with are growing in confidence and independence and are demanding better services, equality and inclusion, a good indicator in looking at their status in this European Year of Disabled People.
	But planning for provision seems to be inhibited by good statistical information. The inquiry found that both broader planning information and information relating to individuals lacked co-ordination and clarity. I wonder whether the Minister could say something about the future of information collection. I save the remainder of our findings for the launch.
	I do not have anything to say about Europe, but I did want to say something in response to the wider debate introduced by the noble Lord, Lord Morris. As the noble Lord, Lord Rix, said, we have much in common with our European partners, but in Asia it is very different and standards are very different; starkly so. In 1995 John Grooms association commenced an innovative partnership with the Centre for the Rehabilitation of the Paralysed in Bangladesh. A nurse educator was seconded to work with CRP at its centre at Savar at what became the leading physical rehabilitation centre in the country. What I see as particularly special about this project, apart from the amazing results on the lives of people who would simply have had no life at all, was the way we worked on a partnership between John Grooms, an Irish funding and support organisation and the staff of the centre in Bangladesh. Alongside complex treatments there were simple solutions such as a ground-level trolley which gives women who are seriously immobilised by paralysis of lower limbs a new way of getting about. Indeed, for some it was whizzing about! Perhaps I may say to the Minister that we could have spent our legal costs on that.
	I have concentrated on the residential care aspect of our work as there is a topical and immediate situation to air and address, but I could have spoken about our brain injury unit filled to capacity and turning away referrals much to the stress and distress of the staff, not to mention the possible users and their families. I join the noble Lord, Lord Corbett, in his comments about that work. I could have spoken of the problems of local authority funding for essential day care because of variation in response of boroughs. I could have spoken of very positive programmes such as our school awareness programme or our lifestyle worker but time will not allow.
	There have been huge changes in the past decade. I congratulate the Government on the fact that, indeed, much has been accomplished. My experience with John Grooms and other associated charities as well as my work in the National Care Standards Commission, demonstrates that there remains much to be done. I hope that the Government will continue to give support to the voluntary sector in its efforts to ensure that the aspirations that people with disabilities have for their lives can be realised in the European Year of Disabled People.

Baroness Dean of Thornton-le-Fylde: My Lords, I, too, congratulate my noble friend Lord Morris of Manchester on securing the debate. I think that most of us anticipated that there would be one but that it was touch and go whether it would be my noble friend Lord Morris of Manchester or my noble friend Lord Ashley of Stoke who would sponsor it. So it is a delight to see both taking part in the debate.
	I need to declare an interest: I am chairman of the Housing Corporation. I should like to concentrate on housing and how it affects people with disabilities. Home is a place—whether it is a residential home, an independent house, flat or bungalow—in which people with disabilities spend much more time than perhaps the rest of us. Therefore, that makes housing even more important to the quality of their lives.
	Early last year, in preparation for this year's European Year of Disabled People, I set up and chaired a group within the Housing Corporation—although it was headed by the corporation, it involved people from outside the organisation itself and from several government departments—to see what we could do, more than we are doing currently, to address this issue. I am somewhat disappointed that the European Year of Disabled People does not seem to have had the high public profile that other years for other subjects have achieved, certainly within the UK. It seems to be a debate that is almost insular within the field of people with disabilities. That is to be regretted.
	In the UK there is a huge unmet demand not only for homes offering full wheelchair access, but also for housing that enables people with non-wheelchair disabilities to enjoy independence. We all want to be independent. The opportunities for many disabled people to be independent and to have their own home are blocked simply because of a lack of provision of adaptations within homes. The provision of a few adaptations would considerably support their lives.
	I guess that I should declare another interest: I am president of the College of Occupational Therapy—a wonderful bunch of people who visit people with disabilities in their own homes, in hospital or in residential homes to see what they can do in order to provide access to improve their lives. Here also the demand for adaptations far outstrips the available resources. There is also confusion. If one lives in a local authority home there is no confusion: it is the responsibility of the social services department. But if one lives in a housing association home, the local authority with a restricted budget will often say, "Go back to your housing association, it is its responsibility". So the person becomes involved in the ping-pong between the two bodies.
	The Government, through the Office of the Deputy Prime Minister, recently published a paper that addresses the issue of adaptations. We very much welcome it. In the group that I chair, housing practitioners expressed concern that the paper, while very welcome, would raise demand because the availability of adaptations would be brought to the attention of people who were currently unaware of them. The situation of demand outstripping availability could get worse. We shall want to follow through that issue.
	A key area of challenge for the corporation with its working partners—whether housing associations or local authorities—is in the design of new homes. We are looking closely at this area because there are what are called "lifetime" homes. In other words, when one builds a home—whatever kind of home it is—should one not take into account that the people going into that home may have different needs during their lifetime? Would they not prefer to stay there rather than having to move out if they become disabled?
	The argument—I must confess that I was in this camp originally—has been that it is too expensive. In fact, with clever design and with clever purchasing and procurement, that argument does not stand up. We are assessing whether we should change how we advise housing associations. We plan to hold a seminar later this year as one of our contributions to the disabled year which will involve not just housing but a broader spectrum—the health department and right across the board.
	There is much to be done. There is no doubt about that. But we are not starting from scratch. We do not feel depressed or discouraged by the current situation. We have a good start point. Over the years, housing associations have provided for very different groups in our communities—for example, the elderly. They are our biggest client group. We have a group looking at housing for older people. The two groups are working closely together. Sheltered and supported housing are other areas.
	We hope that by moving into the new funding regime for supported housing the position will become clearer. We are monitoring it. We do not fund revenue; we fund capital bills. But if housing associations, such as John Grooms, mentioned by the noble Baroness, Lady Howarth of Breckland, do not feel confident about their revenue support in future years, they will not make bids to us for new build. That will start to have a detrimental effect.
	For the debate I asked the Housing Corporation's investment department, "Have the bids gone down for supported housing?" The answer was, "Yes, chairman. This past year we have not had as many bids." It is too early to say whether that was in response to the changes in funding. It may well not be. We are monitoring the situation. I know that the Government would not want that to happen because they support strongly what we are trying to do.
	However, with increasing numbers of us living longer, wanting to maintain our independence, but perhaps later in life needing support to do that, then the supply of the appropriate kind of housing to meet our needs as our circumstances change is very important.
	Another factor that could affect the supply of homes to people who need supported or sheltered housing has not been raised in this debate. And why should it? It is the planning regime—an area not within the Minister's portfolio but as the subject is about housing for people with disabilities it is right that it should be raised. Early this week I met a developer of housing for elderly people. Not all developers are good: they are not all honest and they do not all have integrity. This one is good. He has worked for years in the area. He said to me—quite alarmingly—that in the past year 41 per cent of planning applications for housing for the elderly, despite having been recommended by the planning officers, were turned down by councils. That 41 per cent represented a potential loss of 400 units of sheltered accommodation.
	That developer provides for the private sector, so no public subsidy was being sought. This was in addition to what the public subsidy would provide. We should bear in mind that if one looks nationally at the figures the majority of people moving into that kind of accommodation would come from within a 10-mile radius of the area. In other words, it was local accommodation for local people. It brought to my mind the words, "Not here, not there, not anywhere", the Nimbyism which can be so damaging. In this case it is very hurtful and harmful. The changes in planning would not want to create a situation where that continued. I accept that the matter is not within the remit of the Minister, but we do not want the unintended consequences of changes in the law to affect the planning regime. At the moment an organisation can put in a second bid and, one would hope, get permission to build. That would not be possible under the proposals. We have a requirement as a quango to advise Ministers; we certainly shall do so.
	I said that much is going on and that we are not starting from scratch. We are not. The Government should be congratulated on the support they have given not only through the department to which we account—the Office of the Deputy Prime Minister—but other departments, such as that which my noble friend the Minister represents—and, indeed, the Treasury. Who would have thought that the Treasury would be mentioned in a debate such as this in a positive way? But it needs to be congratulated on a scheme to be launched on 9th May in Reading.
	Ability Housing Association, which specialises in people with disabilities, working with Reading Borough Council, the Reading National Health Service Primary Care Trust and about 30 other housing associations, will be launching the first UK web-based disability register for housing. It will be a two-way register: individuals will be able to log on with their needs; and housing associations will register the kind of housing that they have. I am delighted to say that the private sector has already registered an interest in joining up. That is very positive and helpful and was funded in full by the Treasury under its Invest To Save grant. That is most welcome.
	There are several different schemes up and down the country. We need to know more about them, because we need to bring them to the attention of poor local authorities that are doing nothing. In the spring of 2001, 6.8 million people of working age in the UK had long-term or work-limiting disabilities. We are living longer. That is good, but it means that we must plan better than we have done.
	People with disabilities are within and a part of our society. They are not over there as a separate group. However, too often the approach has been to see them as a special group, an adjunct to society, not as being within it. That is the wrong approach.
	The English built environment is generally inaccessible to disabled people. I agree with what my noble friend Lord Carter said about accessibility. Recent changes to building regulations are definitely improving the situation. Housing associations have confirmed that to me. The whole issue is straightforward: it is about equality, citizenship and treating our fellow citizens equally, in the way in which we should want to be treated if we were in their position.
	In the briefing that I received from various sources, including my party, not one referred to housing. Perhaps that is a statement about housing itself. I am not sure. But housing, I suggest, is critical to the quality of life of people with disabilities. We must recognise the need and what needs to be done.
	It is not just a case of saying what we want the Government to do; it is for all public bodies, all organisations, to consider what they can do to contribute to the European Year of Disabled People. I welcome the debate as a contribution to that year and I hope that when the year ends we shall return to the issues and monitor how we are doing as a nation.

Lord Hussey of North Bradley: My Lords, I apologise for rising unexpectedly at this late moment, but I was in bed at home with 'flu when the debate was announced. I shall not detain your Lordships for long. I simply want strongly to make the point how far things have changed since I was first involved in disability.
	I was wounded in 1944. Six years later, when I was in hospital in Oxford, I remembered that I had been sent some modest pension and wrote to the Ministry of Pensions suggesting that it might like to continue it. I received a letter back stating that it had no record that I had had an amputation and asking, if I had, could I prove it? If I could prove that I had had an amputation, could I provide medical evidence that it had occurred more than six months earlier? That is a true story, which tells us how things have changed in recent years.
	From where I sit as a disabled war pensioner—moving around quite a lot, I am glad to say—it is impossible not to be impressed by and proud of our country because of how much is now done for the disabled. There are toilets, the way that we get shown into a cinema and people who stop to help us in the street. I was pushing a trolley in a station two weeks ago and a young woman stopped and said: "You can't push that trolley; let me push it for you". That would not have happened a few years ago. The improvement in the treatment of the disabled has been immeasurable and a matter of great pride and confidence to all of us.
	Of course, that is not to say that there is not a great deal more that needs to be done. One has only to listen to the speeches of the noble Lords, Lord Morris, Lord Ashley and Lord Rix—moving speeches by people who are informed about their subject—to realise that we are only at the beginning of what needs to be done. However, I want to emphasise how much has been done—much of it due to the public efforts of those three noble Lords.
	Disability is an important, lasting and, in many ways, growing problem. To move away from things such as war injuries—although we cannot move away from them at this moment—I think of my sister, who died at a relatively early age from Alzheimer's. I am bound to say that I think that I am getting it myself now, but leaving that aside, that area demands considerable attention. If one has a relation or is otherwise dealing with Alzheimer's, one realises how difficult it is to get competent, willing treatment.
	Having said that, I got my sister into a hospital near Haywards Heath. When she died a year or so later, half the hospital turned up at her funeral. The feelings are still there, but the needs are great.

Lord Addington: My Lords, the last time that we debated disability, I referred to the usual suspects being in order. When I look down the list of speakers, I find that the top three usual suspects were the first three speakers in the debate. The noble Lord, Lord Rix, has managed to establish himself as a formidable fourth. That group of Peers are people who have maintained in Parliament—not just this House—the on-going struggle to ensure that disability is a subject that is taken seriously here, kept alive and driven through legislation.
	Most of the speeches followed one theme: we have come a long way; things are much better than they were; we are improving all the time; the Government have done well; but so they should and there is so much further to go. We have a reluctant snowball here: every time we go slightly further to improve things, we have to take a bigger step.
	We must involve more departments. I have some sympathy for the noble Baroness, Lady Hollis, who is to respond, because, as the noble Lord, Lord Corbett, and the noble Baroness, Lady Dean, mentioned, one department can never really cover the subject. If disability is basically a civil rights matter, as formidable as the noble Baroness is, her current brief does not cover that. It is also to do with health and education services. We must consider the matter in the round. That is one of the major challenges before government.
	Most of the work that has been done in the field has been piecemeal and patchy. Everyone has been frightened of taking on new ideas and responsibilities and has been sticking provisions on as and when they felt that they had to. How many of us were waiting here last night to speak on amendments about disability to the Broadcasting Bill that we did not reach? The noble Lord, Lord Carter, was one such noble Lord. That is yet another case of pushing the disability issue into other legislation. How many times have we done that? We do it constantly. We constantly try to find holes. The Government have patched up many holes, but unless they agree to take the issue in the round and to bring all the elements together, we will always be doing that.
	I hold the disability portfolio on the Liberal Democrat Benches—they are rather empty at the moment—but I do not want to have to pop up constantly during every Bill to cajole my noble friends and others to support me. I want the Government to seize the opportunity this year—hopeful signs are coming from Whitehall—to introduce a disability Bill that covers most of the principles, at least, and that allows us to have at best secondary legislation and regulations behind us. I conclude that that is the only way to tackle the issue in the long term. No matter how good our intentions, or how friendly we get Ministers to become so that they batter some understanding into civil servants—I feel that at times that has happened—we must try to introduce a basic principle that will make the process easier; otherwise, we will always be tabling that extra amendment and taking on that extra argument.
	The guiding principle that should be adopted in providing practical help for disabled people was much talked about during the debate on the Communications Bill—what is technically possible should be done. By "technically possible" I mean having the technology and resources to implement changes. We return to the concept of reasonableness—it is in the DDA. If that principle is introduced into legislation and government thinking, we will have a much more coherent approach. As the noble Lord, Lord Carter, pointed out, one person in four is touched by disability. Anyone who deals with disability groups knows that it is usually families of disabled people who carry forward movement, especially at the start. If such a principle is introduced, those groups will know what they can do and what they can expect. They will not waste time with unreasonable explanations. They will try to make progress.
	We must put in place a statement of what we expect a disabled person to do as new disabilities are found. For instance, as someone with the hidden disability of dyslexia, dyspraxia was lumped together with it a few years ago but has now been removed from that category. The noble Lord, Lord Astor, also has experience in the field. It is a different group of disabilities, but it nevertheless exists.
	If we continue to expand knowledge about reasons for people's behaviour and why they cannot do certain things, we will not have to write in provisions again and again. I am sure that the Ministers are as bored with the subject as we are. Little will be achieved if we must return to the matter, becoming the group that constantly picks up the same issue. I have heard bar conversations featuring comments such as, "Oh, there is more about disabilities coming in". I have a little information for those fed up hearing about it: I am fed up making the speeches.
	It is to be hoped that, if new legislation is enacted, and we work towards a single commission for equality, we can achieve more. At the moment we are merely duplicating effort and wasting it. However, the Government deserve credit for having at least done more than the previous one and for taking major steps. They are mending or blocking some holes—it would be unreasonable to think that they should not do that. But it is not enough merely to carry on in that way; otherwise, we will not achieve our ultimate goal of ensuring that disabled people have as full a place in society as possible and that unemployed or underemployed disabled groups do not have to struggle and go through hoops to gain basic education rights. It is not about that.
	Dealing with the problems piecemeal will never provide a final answer. We must take on the whole subject so that in a few years' time we can sit quietly, having dealt with the basic principle, and say that the rest is largely automatic. We will probably get the legislation in place, and it may last a fair amount of time. But, eventually, I am sure, technical matters and further research will prove the need to return to the issue. If we cannot stop the problem once and for all, we might at least take a holiday at that point and say that we have done as much as we can for now.

Lord Astor of Hever: My Lords, the House will be grateful to the noble Lord, Lord Morris of Manchester, for giving us, once again, the opportunity to debate the important issue of disabled people. My noble friend Lord Campbell of Croy and the noble Lord, Lord Ashley of Stoke—the usual suspects—have all worked tirelessly to improve the lives of the disabled, as the noble Lord, Lord Addington, rightly said. I am very proud that my late uncle, the Member for Newbury, worked constructively on the issue with all three.
	The noble Lord, Lord Rix, mentioned learning disabilities. In declaring an interest as the father of an autistic daughter, I am personally very grateful to him for all his work in that field.
	The first European Year of Disabled People was officially launched in this country on 20th January. My party fully welcomed the launch. Two days later, the Government's announcement of their intention to publish a draft disability Bill later in the year provided an ideal start. Initiatives designed to increase awareness of the situation in which many disabled people still find themselves, or to highlight good practice in tackling those difficulties, deserve the support of all noble Lords.
	The European Commission has set aside 12 million euros to recognise the event. The UK's share is, I understand, just under £50,000 for launch events and £500,000 for project activities. In addition, the Government have contributed £2 million to support the year. It is important that that extra funding and the spotlight on disability is harnessed to produce effective action, as it represents a real opportunity for the Government to improve their so far disappointing record on disabled people's issues.
	We, on these Benches, respect and support the dignity of the individual. We recognise that tackling the practical problems faced by people with disabilities must be given the highest priority. Like everyone else, they have aspirations and needs as individuals. It is our job to offer them realistic and practical support based on their rights as full citizens. We want to support them in worthwhile employment wherever possible. We are anxious to find and implement practical solutions so that all people, no matter what their disability, can reach parity and play their full part in society.
	The Conservative Party has always been proud to push disability up the public policy agenda. William Hague, as Minister for Disabled People in the previous Conservative government, introduced the Disability Discrimination Act 1995. With the greatest respect to the noble Lord, Lord Carter, in an otherwise excellent speech I feel that he exaggerated the opposition in my party. I took the trouble to check the point with my noble friend Lord Campbell of Croy. We supported recent legislation establishing the Disability Rights Commission and extending those rights to education. Our commitment to those with disabilities, and our concern for the disability agenda, will remain a focal point of Conservative thinking.
	When the Labour Party first took office in 1997, all the signs were good. The 1997 manifesto made a commitment to,
	"comprehensive, enforceable civil rights for disabled people."
	The 1998 Green Paper on welfare reform promised new help to people with disabilities and an "unwavering" determination to ensure that disabled people were,
	"not left on society's sidelines".
	In March 2001, the Government issued a response to the report by the Disability Rights Task Force, From Exclusion to Inclusion, pledging to carry forward work on disability on a number of fronts, including a promise of primary legislation, where applicable.
	Despite the promises and kind words, it is widely felt that improvements on the ground have not been as significant as hoped for. In some instances, the circumstances of disabled people have deteriorated. The Welfare Reform and Pensions Act 1999 represented the Government's first attempt at reforming the welfare system and should have been the vehicle through which it gave substance to its words on disability. Sadly, that was not the case. Many disabled people have still not forgiven the Government for what was described as a pernicious and unfair piece of legislation.
	Through the provisions of the Act, incapacity benefit was subjected to means-testing for the first time. That met with widespread opposition. People who have an entitlement to a contributory disability benefit should not have it cut back because they have had the prudence to build up a pot of savings for retirement. Yet the Government chose to save money by targeting some of the most vulnerable members of society. People with disabilities who have savings over £3,000 gradually lose entitlement to means-tested benefits. Those with savings over £8,000 have no entitlement to income support. The rules for pensioners with savings have been changed, but Ministers have refused to do the same for people with disabilities. For the first time, different categories of recipient are being treated differently.
	Despite pressure from my party, the Government have refused to budge. At the previous election, we promised to increase the capital rules for people with disabilities to bring them back into line with those for pensioners. That would have benefited 15,000 people with disabilities who already claimed income support and 5,000 people who would have become entitled to the benefit for the first time.
	Given that the Government have followed a programme designed to make receiving state support as difficult and as limited as possible, it is not surprising to discover that, under Labour, the numbers of people claiming incapacity benefit has increased by over 100,000 since February 2000. The reason for the increase in claimants is not just the increased number of people joining the caseload but the average length of claims. Around half of all claims last for more than five years. The figures demonstrate an incredible waste of talent, enthusiasm and experience that is being allowed to go unchecked. For some people with disabilities, taking a job will be difficult; for others, it will be impossible. However, for many, employment is what they want and what they need financially.
	Despite the Government's lauding of their flagship programme, the New Deal for Disabled People, the gap between unemployment rates for people with disabilities and for the population as a whole, is still far too high. Despite the headline-seeking aspirations of the New Deal, even the Government had doubts about its effectiveness. Initially, Ministers insisted on excluding one in five New Deal applicants to create a control group by which to judge success. That move was heavily condemned by groups that represent people with disabilities. I am thankful that, belatedly, the Government saw sense.
	There is a similar problem with the Government's approach to supported employment schemes, which have long provided safe working environments for people with disabilities. Ministers believe that people with disabilities should be moved from supported employment into mainstream work, even if it is not their preferred option. As a result, they are likely to be pushed into less fulfilling and lower skilled work than is available through supported employment. Assimilation can be a progression into isolation, the very thing that we must seek to avoid.
	Aids such as artificial limbs, wheelchairs and hearing aids are often the key to independence for a person with a disability: they enable. Yet, in the 21st century, the provision of aids and modern technology is perhaps the worst part of our support for people with disabilities and is well below modern international standards. For those wanting to work or to stay in the labour force, there is often a bureaucratic tangle before anything is provided. As for regular users of aids provided through the National Health Service, there are countless stories of people being unable to get essential spares or replacements without long delays. The equipment, which can make a huge difference to people's quality of life, is often obsolete, is not always in the right place at the right time and is not properly inventoried and tracked. On these Benches, we have recognised that fact, and at the previous election we made the provision of appropriate equipment a cornerstone of our manifesto for people with disabilities. New technologies should be made widely available at the earliest opportunity.
	In November last year, the Government published proposals to reform incapacity benefit in the Green Paper, Pathways to Work. The Secretary of State for Work and Pensions said that the proposals combined,
	"better and more intensive advice with mandatory work-focused interviews, new opportunities for rehabilitation and new financial incentives to encourage people to move into jobs".—[Official Report, Commons, 18/11/02; col. 366.]
	Phased pilot schemes of the new approach in six areas of Great Britain will start from next autumn. We have called on the Government, for some time, to give extra help to people with disabilities who want to work. If the proposals in the Green Paper really will help, we will support them. I am concerned, however, that we have been here many times before. Four years ago, Labour launched the New Deal for Disabled People and began to means test incapacity benefit. Three years ago, they launched the ONE programme. Two years ago, they announced Jobcentre Plus. Last year, they promised a new Welfare Reform Bill to tackle the rise in incapacity benefit claims. None of those measures has reduced the number of disabled people out of work.
	It is vital that the question of adequate flexibility in the interaction between benefits and work is fully addressed. It is also important that the business case for employing a disabled person should be fully made to employers. It is important to use a variety of methods to change attitudes. Furthermore, it is vital that we have a proper and rigorous evaluation of all pilot studies, when they take place.
	It is clear that we still have barriers to overcome in ensuring that all disabled people are able to live in dignity and independence and play their full part in society. The European Year of Disabled People will help to highlight the many issues and difficulties that disabled people often face. On these Benches, we have always been proud to carry forward the disability agenda. We will continue to do so unreservedly.

Baroness Hollis of Heigham: My Lords, I thank my noble friend Lord Morris of Manchester for initiating what has been an interesting and informed debate. I am sure that the House will join me in recording appreciation of the noble Lord's work as an indefatigable champion of the rights of disabled people over many years.
	Interestingly, the debate focused primarily on what I would call the more severe end of disability. I had not expected that. There were the issues raised by the noble Baroness, Lady Howarth of Breckland, to which I shall return, about John Grooms and wheelchair users. My noble friend Lord Carter spoke about the difficulties faced by blind and severely visually impaired people. The noble Lord, Lord Rix, spoke about people with substantial learning difficulties. My noble friend Lord Corbett of Castle Vale spoke about brain injuries. The noble Lord, Lord Hussey of North Bradley, spoke about Alzheimer's. A number of detailed points have been raised, which I shall pursue to the best of my ability and reply in writing to noble Lords. I accept the point made by the noble Lord, Lord Addington, that many of the issues raised today are not primarily the responsibility of my department but reach into the work of other departments, with which I shall consult.
	However, I am sure that noble Lords acknowledge—although possibly not the noble Lord, Lord Astor—how much the Government have done since coming to power to improve the lives of disabled people in this country. Perhaps it is worth reminding ourselves of the distance travelled. We all know that, in general, disabled people have lower incomes and higher costs than those without disabilities—often because they are excluded from work. Therefore, they face reduced employment opportunities and sometimes constrained access to the goods and services, education, travel, insurance, housing and leisure that the rest of us take for granted. To repeat a phrase used by the noble Lord, Lord Rix, it is about mainstreaming their rights as equal citizens.
	I turn first to incomes, which, apart from the noble Lord, Lord Astor, have not been discussed today. In the most basic way possible, income empowers people to make choices. Therefore, I do not apologise for starting with cash before turning to civil rights. Despite what the noble Lord, Lord Astor, said, the Government have done a great deal of work on this issue, but I wonder whether noble Lords realise how much. Many disabled people are elderly and have benefited from the huge boost in the minimum income guarantee which has risen in line with earnings and not just prices—unlike the inheritance from the previous administration.
	In addition, for those people under the age of 60, the disability income guarantee was introduced in April 2001 and is worth nearly £200 per week to a couple. The numbers claiming DLA and AA have risen by one-fifth since 1997. Therefore, last year, nearly £11 billion was paid to 4 million disabled people to help them meet some of the costs of their disabilities, such as heating, laundry, diet and transport.
	I apologise if I am being unfair, but, interestingly, I do not think that anyone has mentioned the issue of disabled children. The financial lift of which I am proudest is that which helps disabled children. In 1997, a disabled child drew £21 per week in income support. That figure has now doubled in cash terms to over £41 per week—a rise during the past six years of over 70 per cent in real terms. No one mentioned that. No one is shouting that from the rooftops. In addition, 40,000 families with severely disabled children also benefit from an extra £16.60 per week for each disabled child. As noble Lords know, DLA has been extended to three and four year-olds so that children using, for example, oxygen cylinders who need help with taxis and transportation receive financial support.
	Putting this in context, the Government have a good record with children. Families with children—not disabled children—have seen a real increase in their average incomes of around one-fifth since 1997. That is good news. But families with a disabled child have received an increase in average family income of over one-third since 1997. That is even better news, as I am sure the House will agree. I am only sorry that no one thought that worthy of mention tonight.
	As many of your Lordships said today, the surest way of helping anyone, including disabled people, to have both a decent income and a full adult life—the life to the years and not just the years to life, to quote the very effective and telling phrase of my noble friend Lord Morris—is to enable them to work and to stay in work.
	We have introduced a range of employment programmes to help disabled people gain and keep work, ranging from Access to Work, WORKSTEP and New Deal for Disabled People. Through the extension of civil rights, we have brought greater protection against discrimination, better access to employment, goods, services and transport to more than 8.5 million disabled adults. In addition, we are opening up more opportunities in education for young people and children.
	Let us look back at some of the major achievements. My noble friend Lord Carter paid tribute to the 1995 Act. I learnt much of what I know about disability as his underling through the battles of 1992 over DWA and the battles in 1995 over the disability Act. I am sure that he would agree with me that although the Act was a milestone, it was, as we argued at the time, a motor car without an effective engine. That is why, after coming to power, we established the Disability Rights Task Force in 1997, paving the way for the Disability Rights Commission—it has just celebrated its third anniversary—which, above all, has made a reality of many of the propositions in the 1995 Act.
	In 1999, we made a significant improvement to rights of access to goods, services and facilities, requiring those who provide services to make "reasonable adjustments" where access is impossible or unreasonably difficult for disabled people. That might include installing a hearing loop system or perhaps allowing a personal assistance dog into areas where animals are not normally allowed.
	From October 2004, service providers will have to take reasonable action to tackle the physical barriers which prevent disabled people accessing their services. That will provide a major boost to the participation of disabled people. We are already seeing many enlightened service providers taking action to improve access to their premises.
	Through implementation of the Special Educational Needs and Disability Act, the first stage of which came into force in September last year, we are providing protection for disabled students and pupils against discrimination. The noble Lords, Lord Campbell of Croy and Lord Rix, made reference to the problem of those people particularly with learning disabilities and their need to be mainstreamed. As the noble Lord, Lord Rix, knows well, based on the White Paper Valuing People, we are working with the Department of Health on the four key principles of rights, independence, choice and inclusion.
	We think that it will take perhaps five years to implement. But with the publication of annual reports, I am confident that your Lordships will keep government up to the mark every year in respect of the degree of progress that we have achieved. We could not be more transparent than producing the annual reports to measure the efficacy of our White Paper.
	Through regulations made under Part 5 of the Act, we have ensured that many new road and rail transport vehicles are more accessible to disabled people. In addition, we are implementing Article 13 of the European directive on employment two years earlier than necessary. I shall speak to that in greater detail later.
	However, legislation is not enough. Lack of work is one of the most common sources of social exclusion and disabled people are still approximately seven times more likely to be out of work and on benefits than non-disabled people. Strikingly, the degree of severity of disability is no indicator of the degree of likelihood of exclusion from work. I am sure that the noble Lord, Lord Carter, will not mind if I refer to his family. His daughter who has what appear to be overwhelming disabilities has none the less held down an important job very successfully. Yet only 11 per cent of those with what many might regard as mild to moderate mental health problems, such as stress or depression, are in work.
	There is a real difficulty in seeking how best to overcome mental health issues in particular. I am the first to admit that the Government have not yet got this right. It is one of the biggest areas of difficulty. We are not dealing with a disability that is visually recognisable and therefore a perceived stigma needs to be overcome. Nor are we dealing with a problem of physical access which would allow for a bricks and mortar adjustment. This issue is much more profound and much harder to overcome. This disability spills into an area of almost sickness-like problems and, to some extent, some disabled people with mental health problems interlock with the employers' stigma to exclude them from the labour market when they still have so much more to offer.
	In the field of learning disabilities, my noble friend Lord Corbett spoke movingly and powerfully about the problems faced by young men with brain injuries. We are working with the Department of Health to take into account the new national service framework for long-term conditions announced in 2001 by the Secretary of State for Health. We plan to publish the framework next year. I shall ensure that my noble friend's comments are taken into consideration. He was right to point out that some of these issues cut across government departments, but that is the price we must pay if we want to fulfil our wish to see disabled people integrated into the mainstream of every walk of life, whether it be education, transport, housing, the environment or income and financial support. Inevitably, that results in a more fragmented approach than would otherwise be desired.
	My noble friend Lady Dean raised the issue of housing. I am glad that she highlighted this matter in her remarks because, as she so rightly pointed out, too often it is an area that is overlooked. My noble friend will know that since October 1999, Part M of the regulations applies to new housing, making such housing accessible to disabled people. My noble friend recognised that we are currently consulting on what should be done about existing property and the propriety of further extending the regulations. We very much welcome the work of her corporation. She will know better than anyone that around 13 per cent of Housing Corporation expenditure is being allocated to housing for people with supported housing needs.
	My noble friend also spoke of the position with regard to sheltered housing for the elderly and described how some private development proposals have been rejected, at least initially, by local authorities. I do not know the background, but my experience in local government suggests that, increasingly, rather than opting for new-build sheltered housing, local authorities are seeking to keep disabled and elderly people supported in their own homes. I know of at least one major housing association which has recognised that it faces a problem with regard to its supply of sheltered housing as a result of that policy. People's aspirations have changed from those of 20 years ago when some sheltered housing was being built. I do not know whether that development lies behind some of the problems described by the noble Baroness, but I shall pursue the matter. However, it is the case that, increasingly, the thrust of the services being offered by local authorities is changing. Equally, local authorities are now offering choice-based lettings and we are seeking to expand good practice in this area.
	The noble Baroness, Lady Howarth of Breckland, raised issues associated with conflated council tax as opposed to disaggregated council tax, where it was possible that what lay behind a façade of seemingly separate flats, was in fact a heavily supported, interdependent mutual living arrangement. Given that the case she mentioned may be going to appeal, the noble Baroness will not expect me to comment in detail. However, I was a little puzzled because many years ago I was involved in setting up sheltered and halfway housing in Norwich for people with physical and learning disabilities. Since the introduction of council tax, I know that not only is it possible often to rebate a band down by virtue of that type of accommodation, it is also the case that practically every resident is entitled to a full rebate of their council tax. I wonder exactly how the problems outlined by the noble Baroness have arisen, given my own experience in this area. If the noble Baroness would be kind enough to write to me, I shall take the matter further and check to see whether I am missing any tricks here.
	Before I turn to the European Year of Disabled People I, too, along with my noble friend Lord Morris, want to highlight the 25th anniversary of Motability. It was founded in 1977 as a partnership between government, charitable and the private sectors to help provide transport for severely disabled people. The scheme has offered choice in meeting transport needs by making available mobility allowances, leasing cars and so forth.
	The first Motability car was supplied in 1978. Since then, over 1.5 million cars have been provided to disabled people and their families. Currently, 400,000 people are benefiting from the scheme. I join with my noble friend in praising the vision and insight of its founders.
	I turn now to the European Year of Disabled People. The European Commission originally made available almost £550,000 to the UK to promote the European year. We matched that sum with a further £1 million from the Government. Following a comprehensive bidding process, our co-ordinating committee received almost 1,200 bids for funding. Such was the high quality of those bids that the Government made available a further £1 million to help an additional 78 projects, thus aiding 171 in all. Throughout the exercise, our concern was that it should be for disabled people themselves to organise, run and benefit from these schemes. They are the schemes of disabled people rather than for disabled people.
	Perhaps I may give a flavour of the different proposals that received support. Schemes that made successful bids include a multi-disabled football league in London; support for disabled parents to help them in their parenting skills in Berkshire; training videos in advocacy for young learning-disabled adults; work with minority communities, including Asian and Latin American families; dementia awareness training in Merseyside; access facilities for countryside paths; work to promote the sexual health of young disabled people in Stockport; and a mental health arts project in Sussex. I could go on. What is most impressive is the vitality, range, and high quality of these locally based skills.
	The European year also gives us a great chance to take stock of where we are in terms of civil rights for disabled people, to review what we are doing and to raise awareness. Noble Lords will know how much of this work has been carried out by other departments. We lead on the Disability Discrimination Act. Although the Disability Rights Task Force made 156 recommendations for change, only a minority of them concerned changes to the DDA. Many of those recommendations have already been implemented, while others will be dealt with.
	Transport Ministers have just completed a consultation exercise looking at how to protect from discrimination disabled people who wish to use buses, trains and aeroplanes. That, too, was a task force recommendation. Ministers in other government departments are pursuing task force recommendations and, as I mentioned earlier, we are bringing forward by two years a key employment directive to ensure that even companies employing only one person will no longer be able to use that as an excuse to discriminate against disabled people. As a result, for the first time 1 million small employers, covering 7 million jobs and employing 600,000 disabled people, will be brought under the protection of the DDA.
	At the launch of the European Year of Disabled People in January, the Secretary of State announced our intention to publish a draft disability Bill later this year. As I expected, my noble friend Lord Ashley of Stoke has pressed me on this. The draft Bill is being published so that it can be looked at by a parliamentary committee which can give us advice if it thinks anything needs to be changed. We have yet to determine the most effective way of setting up that scrutiny. We are also still considering what should be put in the Bill, but we are thinking about other recommendations from the task force. For example, we are looking at extending the DDA definition of disability to more people with HIV and cancer; making sure that public bodies promote the needs of disabled people; ensuring that activities such as the issuing of licences are not counted as services and so are not covered at the moment, and ending the exemption of transport services.
	We are seeking to extend further in the Bill our manifesto commitment to ensure basic rights and opportunities for disabled people. However, my noble friend Lord Ashley and other noble Lords will know that at this stage I cannot comment in detail on the content of the legislation, except to say that I look forward to the debates that I expect us all to enjoy as and when we secure the necessary parliamentary time.
	I hope that the issues I have mentioned—our work to raise the incomes of disabled people; our work to achieve further advances in regard to the Disability Discrimination Act; our work on extending rights of access to goods and services; the initiatives we are sponsoring under the European Year of Disabled People, and the work we have in progress for what I hope will be a further disability Bill—will convince noble Lords that this Government take seriously the European Year of Disabled People not only for one year, but for the generation to come. I hope that, as a result, we shall all enjoy each other's support on these issues.

Lord Morris of Manchester: My Lords, again I am most grateful to everyone who has spoken in the debate. Your Lordships' House always excels in debating the problems and needs of disabled people and that was eloquently set in bold relief in a debate of high quality today.
	As my noble friend Lady Hollis made clear, she will be responding to any unresolved questions put to her; and I know that she will do so with all her customary care and concern.
	My noble friend is aware of my interest in vocational rehabilitation for people who have suffered traumatic brain injury, an issue which my noble friend Lord Corbett addressed so well in his speech, and I hope that there will be further opportunities soon to debate that and some of the other issues raised in the debate by my noble friend Lord Ashley, the noble Lord, Lord Campbell, and in one impressive speech after another from all parts of the House since they spoke.
	One regret that I have is that we could not address at more length today the pressing need to maximise the prevention of easily preventable disability. Four out of five blind people live in the Third World and four out of five of them are preventably blind—a deeply shaming fact. Yet as that inspired crusader against avoidable disability, the late and widely mourned Sir John Wilson, so clearly demonstrated, the cost of saving people in the Third World from preventable disability has been falling as dramatically as its incidence there has increased.
	All too often now one hears grossly complacent talk of the huge advances made by medical science in eliminating one after another of the age-old scourges of mankind. But there is scant room for complacency when HIV spread, the renewed menace of malaria, superbugs and SARS—to name but some of the new scourges—are posing such daunting problems across the world.
	This is but one reason why everyone who can contribute to reducing the long agenda of unmet need in this policy area must go on doing so. Meanwhile, and thanking again all who have contributed to making this debate so memorably worthwhile, I beg leave to withdraw the Motion.

Motion for Papers, by leave, withdrawn.

Tourism

Lord Pendry: rose to call attention to the place of tourism in the United Kingdom economy; and to move for Papers.
	My Lords, I am pleased to have secured this debate as I believe that the tourism and hospitality industries are not given enough prominence in either this House or another place. I immediately declare an interest as chairman of the All-Party Parliamentary Tourism Group and, for five years, shadow Minister for Sport and Tourism.
	Those of us who take an interest in tourism are well aware of its importance to the UK economy. Tourism in Britain is not often acknowledged as a huge contributor to the economy—to paraphrase a Select Committee report in another place it is a "sleeping giant"—but tourism is our fifth largest industry. In fact, tourism ranks fifth in every English region in the country and is much higher in Scotland and Wales. Worth £76 billion in 2002, tourism affects the lives, as we know, of every citizen. Over 2 million men and women work in tourism—more than 7 per cent of the working population—and the Treasury receives nearly £8 billion in tax every year from the sector. So it is clear that tourism plays a huge role in our national prosperity.
	The past three years have seen a series of crises hit the sector. Foot and mouth and September 11th led to a massive loss to the sector of about £8 billion in 2001. Many businesses collapsed, despite the assistance provided by the Government. The first half of 2002 saw the beginnings of a recovery, but tourism is once again in trouble. I want to draw the attention of the House to the current situation—which is affected by the consumer-led economic slowdown and the situation in Iraq—and what should be done about it.
	The British Chamber of Commerce quarterly economic survey showed a significant decline across the whole economy, particularly among small businesses—tourism is of course disproportionately made up of small businesses, more than 125,000 of them, from cafes to B&Bs and small attractions—and all this in the context of a slowdown in UK consumer expenditure and the Chancellor's lower economic growth estimate for this year, down to between 2 and 2.5 per cent.
	This bad news has been reinforced by a sharp loss of confidence among tourism businesses. Surveys have shown that in the first quarter of 2002, 66 per cent of businesses were "more optimistic" about the future for the sector against only 5 per cent which were "less optimistic". By the last quarter, only 28 per cent were "more optimistic" and 44 per cent were "less optimistic". There are also some worrying signs of a decline in employment levels.
	The build-up to the war in Iraq has of course been a major concern, affecting the willingness of people to travel generally and, in particular, to countries involved in the conflict. Together with the outbreak of the SARS virus and the advent of the ever-present global threat of terrorism we are seeing a decline in the willingness of people to travel across the world, which mitigates against growing inbound tourism—a vital contributor to wealth and jobs.
	The latest visitor numbers for 2003 are robust for international visitors from Europe but potential travellers from long-haul markets were more subdued by the approach of war and visitor numbers are down. It is visitors from the US and other long-haul destinations who spend the most when they come here.
	For UK residents holidaying within Britain, the fragility of consumer confidence has also seen a deterioration in tourism. The number of trips and overnight stays taken in England were up by only 2 per cent on 2001, the "low tide" year of foot and mouth and September 11th.
	After the events of 2001, it was clear that the Government should review the public structures in place to support the tourism industry. Last year the Treasury contributed £20 million towards the extremely successful "Only in Britain, Only in 2002" campaign in key overseas markets. This was matched by £20 million from the industry. Longer term, the Government decided to merge the British Tourist Authority and the English Tourism Council into VisitBritain, a single lead national agency for tourism, which now has a domestic marketing responsibility for England. Campaigns within the UK, Europe and other key overseas markets are already in the pipeline.
	The Government's moves are admirable. In Dr Kim Howells tourism has a real champion, as was his predecessor Janet Anderson, but we shall have to wait to see the long-term success in the future as the structures bed down. But the short-term situation caused by the Iraqi situation and a drop in consumer confidence demands action now. I am confident that the Government are monitoring the situation and are considering what assistance they can give to struggling tourism businesses. I look forward to hearing from the Government Front Bench what is the Government's current view.
	I believe that there is a need to consider resurrecting the Government's policy towards PAYE and VAT holidays for tourism businesses. Flexibility in the payment of business rates, tax and national insurance contributions proved a lifeline during the foot and mouth outbreak. It could prevent the need to lay-off staff and thereby save many businesses at this tough time. Another taxation measure could be to make trips to Britain instantly cheaper by reducing or suspending air passenger duty for a specified length of time.
	Secondly, DCMS Ministers should consult with the Treasury over whether to put extra one-off resources from the reserves behind another large campaign this year along the lines of "Only in Britain, Only in 2002", together with industry match-funding.
	Thirdly, the British Tourist Authority has faced a standstill budget for many years. Costs and wages have risen in line with inflation but not its grant-in-aid. Even worse, the budget for the English Tourism Council has been in severe decline. Both bodies performed successfully against their briefs. Now that the Government have merged them into VisitBritain it is surely time to update the grant-in-aid for the long term and correct this shortfall.
	We all know that money alone does not necessarily deliver the right results without the necessary reforms, but the Government have now made the necessary reforms and we should see the investment that goes hand-in-hand with those reforms to achieve the results the country needs.
	While appreciating the recent structure changes, marketing on its own is not enough. We need to ensure the industry has enough people with the right skills to deliver a quality product. We need better co-ordination between the various agencies and to establish a properly funded sector skills council for tourism, hospitality and leisure.
	I believe the Labour Party has a good tourism record. After all, it was Labour that introduced the original Development of Tourism Act 1969, creating our national tourist boards. I was proud, as shadow Minister for Tourism, to draft Labour's first ever policy on tourism and hospitality, Breaking New Ground, before the 1997 election. Surely it is now time to revisit the 1969 Act. Devolution to Scotland and Wales and further tourism responsibilities moving to the English regional development agencies and possibly regional assemblies will mean that the realities of devolution, the existence of VisitBritain and the formation of an England marketing advisory board within VisitBritain are not reflected currently in legislation. The Government have pledged to update the legislation, parliamentary time permitting. My argument is that tourism should be high on the government agenda and the time should be found now. If the Government have belief in their reforms, they should put them on a statutory footing.
	Our heritage, coastline, countryside and cities already attract much tourism activity but we should enable innovative local changes so that tourism links in with local community needs as well as those of the visitor. In my own area, the traditional fell-walking activities and Great Parks at the foot of the Pennines are supplemented by events such as the Tameside brass band festival, which includes the route of the revamped, cleaned, regenerated canalside in Stalybridge. As the local MP at the time, I was proud to play a part in bringing the local authority and the Millennium Commission together to provide the necessary funding for that development. As a result of the canal being restored, the inward investment into Stalybridge is to the tune of some £80 million. At the end of the Stalybridge town centre project, it is estimated that that will double within five years to approximately £160 million.
	Synergies between tourism and the fields of sport, arts and culture surely make up a major key to success. I am on record in your Lordships' House encouraging the Government to back the Olympic bid for London for 2012, as the potential rewards for the whole economy are huge and the benefits will spread across the country. I look towards Barcelona and Sydney as shining examples of what could be achieved here.
	The Government's introduction of free entry to national museums and galleries is a fundamental step towards improving access, although we should look at steps to assist other independent museums, galleries and attractions, especially those in the regions. Could the Government consider extending the VAT recovery scheme to all museums and galleries? Could the National Lottery Commission be encouraged to target funding towards tourism-related projects? I look forward to hearing the Government's view on that.
	I now wish to turn to the need for government support for our seaside resorts. Speaking as one who was brought up in the seaside resorts of Broadstairs and Ramsgate, I have a certain affinity with those who argue the case for the restoration of our resorts. I would like the Minister to promise to convey to the Secretary of State the need to read a report about to be published by Sheffield Hallam University which smashes many of the myths surrounding the state of many of our resorts.
	For instance, the study examined 43 principal resorts. Combined, these resorts have an adult population of working age of 2.9 million, which compares with a figure of 3.2 million for the whole of Wales. Between 1917 and 2001, the number of people employed within these resorts actually increased by some 217,000.
	So where does this leave the traditional seaside resort? Well, it still leaves them with many difficult social and economic issues to face, often of a similar nature to those experienced in inner-city areas. On the positive side, it leaves them with a new understanding that tourism is not the root cause of their difficulty, but actually a major part of the potential solution. It leaves the Government with a better reason and a much stronger justification for their continued keen interest in seaside resort tourism. It also gives much greater incentive to encourage RDAs and other key bodies to invest in resorts' general infrastructure and now, critically, directly into tourism-related projects.
	Previously, it has been very difficult to justify an enthusiasm for resort tourism when the perceived wisdom suggested that it was a failing industry. If, as I understand to be the case, the Sheffield Hallam report shows clear evidence that resort tourism is alive and well and capable of more growth, it should be much easier to identify specific methods of tackling the social and economic problems, while in parallel working to stimulate more tourism growth to improve the economy for the benefit of all residents and visitors alike.
	Britain has some of the greatest tourism assets in the world. Through regeneration, an improved transport infrastructure, and working in partnership across a range of fields, we can ensure that UK residents visit and enjoy more of their own country, and that international visitors want to return. Only when government can draw together industry, regional agencies and local authorities can we ensure that Britain gets its fair share of the economic benefits of a successful, sustainable tourism sector that can compete with the rest of the world. I beg to move for Papers.

Lord Montagu of Beaulieu: My Lords, first I must declare my interest and involvement in tourism. Since I made my first speech on tourism some 50 years ago, it is more or less a question of confirming it.
	The whole House will be very grateful to the noble Lord, Lord Pendry, for raising this important subject this afternoon. Before he was elevated to this House, he was very active in another place and has always been a great friend and supporter of tourism.
	What is rather depressing in re-reading these old debates over the years is finding the same old problems being brought to the attention of successive governments by speakers from all parties in the House. It is very easy for us to say, "We told you so", as, over the years, there has been a complete failure by successive governments to invest in tourism. Instead, they have—mistakenly, I think—concentrated on altering and interfering with structures. For instance, as far as England is concerned, first we had the English Tourist Board, with its relevant powers, then we had the English Tourism Council, with no powers, and now we have another body called VisitBritain, which apparently has some resources to market England. What was wrong in recent years was the presumption, which was quite wrong, that the regions would together be able to market England competently, even though they are all in competition with each other, leading to a fragmentation of efforts.
	It took an apparently unrelated crisis, foot and mouth disease, to reveal the true value of tourism to Britain and the inability of the then tourist agencies to react positively as they had neither the staff, the experience nor the resources to carry out the necessary marketing, so money had to be rushed from the Treasury for these purposes.
	The benefits of tourism are felt at all levels of the economy. Tourism is worth four times as much as agriculture and sustains four times as many jobs. It generates more than 15 times as much tax to the Exchequer, yet successive governments' recognition of tourism has been limited and very short lived.
	While the creation of the new marketing body for England is generally welcomed, the additional funds made available of £10 million over three years are just not enough. The RDAs are indeed providing some additional funds at the regional level, but at the same time, resources to the centre have been cut, and England no longer has a fully competent national tourism body. Successive Select Committees have identified governments' substantial under-investment in tourism.
	Now we are in a period when the financial outlook for Britain is worsening. The Chancellor of the Exchequer has reduced all his expectations. Authoritative and independent analysis expects that the position could become very much worse in the future. Britain needs to make use of every opportunity to invest more and help boost the economy. Tourism is one of the few industries capable of making a massive contribution, but for the past decade we have been losing out, with the net positive balance of payment on the tourism account declining in 2002 to a negative balance of £15 billion. The situation could even get worse, but that is not inevitable; the deterioration could be reversed.
	The BTA has proved the value of investing in the ability and experience of attracting tourists to Britain against the ever-strengthening competition of other countries. For every £1 that the BTA is able to spend promoting Britain, an additional return of £28 is earned. How can that opportunity be repeatedly ignored?
	After foot and mouth disease and the impact of September 11th, the Government responded with additional funding. Now, with the Iraq war and SARS impacting on our tourist industry, typically it has been announced that no additional funding from Government is planned. Tourism has always been vulnerable to major disruptions, and the cost to our industry and to jobs can be enormous. We need an early commitment from the Government to be prepared to provide a long-term investment to help Britain to improve the tourism infrastructure and win its share of demand against ever-growing competition from other nations. More than ever before, we cannot afford to neglect our tourism potential. We do so at our peril.

Lord McNally: My Lords, when I joined this House seven years ago, one of the earliest debates in which I participated was on tourism. In that debate, I also followed the noble Lord, Lord Montagu of Beaulieu, with some sense of awe, since his name is associated with one of our most successful tourist enterprises. Indeed, I pointed out at that time that he and I occupy almost diametric opposites of the tourist experience in that he was one of the pioneers of saving our stately homes heritage through tourism. My experience was of selling coffee on top of Blackpool Tower. The highlight of that experience was an article in the local newspaper with the headline "Tower Top Tommy"—one of the more favourable pieces ever written about me.
	My Blackpool background meant that I never treated tourism as a second-rate industry. I was brought up with the knowledge and appreciation of the jobs and the wealth that tourism created. It also left me with the conviction that there is a difference between service and servility. Being in service industries is in no way demeaning; indeed, one of the great satisfactions, as any good chef will say, is being able to provide good high-quality service to a satisfied customer. That is one of the things we need to encourage. We must get rid of for ever the concept of "rip-off Britain". It will take the efforts of everyone involved to ensure that what people get when they come to Britain for their holidays is of the highest value and quality.
	The problem is that tourism has been something of a Whitehall orphan. It has been bounced around various Whitehall departments and has always been a subsection of a junior Minister's responsibility. Although the approval expressed by the noble Lord, Lord Pendry, is, I am sure, appreciated, I remain unsure whether Kim Howells wants to be tourist Minister or art critic. That is part of the difficulty.
	When one listens to the noble Lord, Lord Pendry, one is always tempted to say that he was the best tourist Minister we never had. Certainly, the work he did in opposition on tourism and hospitality was a document that cut across party dogmas in giving a blueprint and a way forward for the tourist industry. In his opening remarks, he rightly highlighted the trials and tribulations that the tourist industry has gone through in the past few years. It is not treating the situation frivolously to suggest that it is almost like watching "The Perils of Pauline" in that there has been 9/11, foot and mouth, various acts of international terrorism and recent wars. The industry has been buffeted, buffeted and buffeted again. Now there is the possibility of an economic slowdown influencing it further.
	But there is an opportunity in this challenge. We may see, perhaps only for a short time, a change in tourist patterns. The exotic holidays, which were becoming increasingly attractive to British tourists, may seem less so in a rather more dangerous world. This represents a real opportunity for the British tourism industry to sell its benefits to the British people. The more exotic holidays may also be less tempting to some of the foreign tourist markets, and we may also attract them. Most importantly, the British tourist industry and the relevant agencies should use this year to attract British tourists back to holidaying in Britain.
	I have done some pioneering myself. I have a young family: a 7 year-old, a 9 year-old and a 12 year-old. Without being too pious, I decided some time ago that part of their education should be to discover their own country as well as having the opportunity for foreign travel. In recent times we have been to Torquay, Weymouth, the Gower, Blackpool and the Lakes. Going to Blackpool was of course an essential part of their cultural development. They enjoyed the Tower Circus and the Pleasure Beach, as I did 40 years ago.
	In those visits, as the noble Lord, Lord Pendry, said about the Sheffield Hallam study, I found that the state of British tourism—especially of our seaside resorts—is nowhere near as decrepit as some of the publicity suggests. There are really good family holidays, with good entertainment, at our leading resorts. To visit the Gower or the Lakes, or to do, as we did, and take the road from the Lakes to Leeds through the Yorkshire Dales National Park to join the M1 gives one a breathtaking realisation of our national heritage.
	I pay tribute to the management of our national parks. I was extremely impressed by the signage and facilities, which make a visit to a national park such an added pleasure for a townie like me. One can judge which directions to take. There is plenty of help available; there are many facilities. So that side of tourism is there and waiting for the British people. However, leadership is required if people are to take advantage of the opportunities. As the noble Lord, Lord Pendry, indicated, funding will also be necessary. We need a sense of urgency if we are to capture that opportunity.
	Not only the holiday areas can benefit; opportunities exist also for the larger cities. The message is coming home to cities that tourism is important, and they are responding. Just over 10 years ago, I did a study for the Mersey Enterprise Board about the type of things that attracted people to Merseyside. It was amazing to learn what a strong selling point Merseyside's artistic, cultural and sporting assets were in attracting tourists. As anyone who has gone to Manchester, Liverpool or Birmingham will know, the combination of cultural and other assets makes a city visit extremely worthwhile. The competition for designation as City of Culture has demonstrated how one asset can be balanced against another and the sense of community that is delivered. As for sports tourism, the Manchester Commonwealth Games have left a lasting legacy which will boost that city's tourism. I therefore strongly endorse what the noble Lord, Lord Pendry, said about going with vigour for the Olympics.
	I realise that tourism has some severe problems. However, from my recent visits to tourist areas around England and Wales I know what those areas have to offer and the quality of which British tourism is capable. That potential really does deserve a response from government and government agencies. During these times of international uncertainty, we should grasp that potential gap in the market. Having attracted Britons back to Britain this year, the tourist industry at every level should also ensure that, because of the quality of what they experienced, people are determined to come back again and again.

The Lord Bishop of London: My Lords, I, too, wish to address that issue of quality. I welcome this debate on the place of tourism in the British economy and am grateful for the opportunity. I should, however, declare an interest as chairman of the Cathedrals and Churches division of the Church of England.
	Noble Lords will be aware that, in the beginning, mass tourism and religion were partners. Thomas Cook was, of course, a notable Baptist temperance campaigner. The very first package tour that he organised was an 11-mile rail journey from Leicester to attend a sober rally in Loughborough. An inclusive price was charged for both food and transport, and so mass package tourism was born.
	The partnership between religion and tourism is not only an historic theme; it is a very contemporary theme as well. Religious buildings of all kinds in our country are not only magnets which draw tourists and their money to major heritage sites such as neighbouring Westminster Abbey or York Minster; they also divert tourists into the depth of the countryside, perhaps with Mr Simon Jenkins' guide to the Thousand Best Churches in hand. Religious buildings can even draw people to very unfashionable parts indeed. There is a trickle of tourists to the church of St John's Hoxton—which, with English Heritage, we have recently restored, including a marvellous painted and rather genteel Church of England Apocalypse overhead. It has attracted quite a stream of tourists to Hoxton, which is not the usual sort of venue that comes to mind.
	So religious buildings such as the spectacular Hindu temple in Neasden attract millions of visits each year. I wonder how many tourists would miss the pleasures of visiting Wells, for example, if the cathedral there did not act as a magnet. As we heard, such attractions bring great economic advantages to the areas in which they are set. They also contribute powerfully, and incidentally, to a deeper sense of local identity, not least for the newer British communities.
	However, that comes at a cost to those responsible for the upkeep of tourist magnets and attractions. The steep rise in visitor numbers which we have experienced in the past 30 years has also seen an increase, quite rightly, in the legislation covering the care of visitors, especially the care of children and—remembering the previous debate—the care of those afflicted by disabilities, and the accessibility of attractions to them. At the same time, stricter regulation aimed at conserving our tourist attractions has resulted in an increase in the cost of maintaining them.
	Of the million or so visitors who come to Canterbury each year, many are French or German. They assume, of course, that the Government bear the cost of maintaining such an important and attractive part of the heritage of the whole community and not just one faith community. Such visitors are often astonished to discover that what they take for granted in their own country is not true in Britain, where thousands of volunteers—and we are not whingeing about this; we are proud of it—connected to all the faith communities of the country do the work and raise the money that is a charge on public funds in nearly every other European country.
	Canterbury Cathedral, for example, has never received an English Heritage grant. However, if you have a million visitors a year, the building needs to be presented and preserved—we have heard the accent on quality and a memorable experience—in a way that offers the tourist a welcome, an experience and, if required, an education. Even visitors from Great Britain—currently increasing in numbers for the reasons we have heard—assume that the £3.50 charge to visitors at Canterbury is just netting a little money on the side for the cathedral over and above what it receives from a generous public purse. That is how they perceive it. Such charges are in consequence often resented and comparisons are drawn with the free entry policy at museums and galleries.
	Yet—and this is the crucial point for this debate—the money from visitors at such a place is not used to keep the services going or even to keep the building standing. In Canterbury's case, it is used chiefly to provide the facilities to cope with the demands of mass tourism, to care for the visitors and keep them secure and to make good the wear and tear of a million pairs of feet.
	In a country such as ours of voluntary religious communities, it is the business of each faith community to finance the religious purposes of its shrines. In the case of the Church of England cathedrals, their primary purpose is defined by legislation as being centres of worship and mission. No one is asking for any kind of state subsidy for such activities. However, it is important to all those who care for quality in our provision for the tourists at home and abroad, and extremely important for all those involved in tourism—we have heard again and again the statistics which illustrate the sector's importance to the economy and the employment it provides—that heritage sites should be properly resourced to offer a memorable experience to very numerous and very diverse visitors.
	English Heritage has a modest annual budget of £2 million for its Cathedral Repairs Grants Scheme. It seems to me that the larger sums available to promote tourism and sustain attractions must be viewed with a strong assumption that there must be an argument for considering the eligibility of clearly defined aspects of visitor welcome and presentation. Those aspects of spiritual heritage attractions should be considered on a similar footing to some museums and galleries as beneficiaries of those programmes.
	So, while welcoming the debate, I hope very much that it can help us to see certain aspects of the challenge of maintaining such a significant part of our communities' inheritance in a new and possibly constructive way.

Baroness Dean of Thornton-le-Fylde: My Lords, I congratulate my noble friend Lord Pendry on initiating the debate. I congratulate him especially on calling attention to the importance of tourism to the United Kingdom economy.
	Tourism certainly makes an important contribution to the United Kingdom economy. It fosters growth in the building industry, the motor industry and the aircraft industry. Many industries get a spin-off from tourism. But putting that on one side, as has been said, our tourist industry was worth over £70 billion in 2002. However, the figure will be less this year. Some 2.1 million people are directly employed in tourism and 127,000 businesses are involved in it, 80 per cent of which have an income not exceeding a quarter of a million pounds a year. The latter point is probably one reason that tourism and the economy do not necessarily go hand in hand in the public's perception.
	Britain is good at tourism. We have the fifth largest tourist industry in the world. Yet it does not have the high profile that many of our other industries have. Perhaps the onset of foot and mouth started to make the public realise the impact that such events have on the lives of people in rural communities who are involved in tourism. Certainly, those who were not convinced that the foot and mouth epidemic had a negative impact on the tourist industry must have been convinced that the tragic events of 11th September had a negative impact. Then the war with Iraq broke out and now there is the problem of SARS. I cannot think of any other industry that has suffered four such consecutive crises. The tourist industry must be reeling and wondering what is coming next.
	The tourist industry is going through a tough period. We can see that in this great capital city of ours. Last night I went to a West End theatre that was half full. The other day I got into a taxi and the driver told me that I was the first fare he had had for an hour. I said that I thought my fare would be only about £3.50 but the driver said that it was better than nothing. Those involved in the tourist industry are under economic pressure. Hotel occupancy rates are well down.
	The campaign to encourage people to visit Britain is certainly very important. A fall of 15 per cent in visitor numbers is anticipated compared with last year. ABTA says that bookings are down by 16 per cent. Although ABTA tour operators deal mainly with outbound tourism, they employ 133,000 people here in Britain. Certainly, the decline that they face may well result in job losses in a sector where I gather the average net profit is just over 1 per cent. So they do not have much of a margin to play with.
	Some 2 million people work in the tourist industry and, as I said, last year the tourist industry was worth over £70 billion. I compare that sector with the industrial sector. Yesterday headlines in the press announced the 1,100 redundancies—that is an approximate figure—at Corus. The media gave that matter huge coverage. The tourism industry is four times the size of the agriculture and farming sector in the UK with four times the number of employees. About a third of a million people work in the farming industry. Yet at no time during the foot and mouth crisis did the media give much coverage to the impact of the crisis on the tourist industry and on people's jobs in that industry. As my noble friend Lord Pendry said, the VAT and pay-as-you-earn holiday that was granted at that time was a lifeline. As he said, perhaps we should consider doing that again.
	It is generally recognised that the tourist industry is having a tough time. It is one of our new industries. It has grown and has to some extent taken the place of our former great manufacturing industries in terms of the number of people it employs. I refer in that regard to the shipbuilding industry, the steel industry and the coal mining industry. Tourism is an industry with a large economic involvement in our communities. Although it appears glamorous, it is a terribly important part of our economy.
	The industry will bounce back; I do not think that there is any doubt about that. After the Gulf War the industry recovered very quickly. It was starting to make a strong recovery after the foot and mouth epidemic when the events of September 11th occurred. It seems that each time the industry recovers, something else has come along in the past two years to knock it back.
	The industry needs nurturing. I do not think that it is whingeing or pleading poverty. However, it is an important sector of the UK economy. The noble Lord, Lord McNally, was right to refer to ABTA. At the moment 10 per cent of its work is within the domestic holiday market. Some 61 per cent of its members have said that they will invest more in the domestic holiday market. In Germany, for example, domestic holidays account for half of travel agents' business. Their overseas business probably mainly involves holidays in Spain.
	Should an industry that is so important to our economy have its own Minister? My noble friend Lord Davies of Oldham will say that tourism has its own Minister, Kim Howells. The industry considers that he is a very good Minister. However, when the tourist industry—which employs 2 million people—is in crisis, it is not helpful for Kim Howells to devote day after day to the Ofcom Bill. As I say, Kim Howells is a very good Minister but this very important industry would gain a higher priority in his portfolio if he was able to devote more time to it.
	There is a strong case for bringing the tourist industry under the remit of the DTI. I should be surprised to hear my noble friend Lord Davies of Oldham agree with that point. However, one could argue that tourism is an economic rather than a heritage matter. That point should be considered.
	I hope that the industry will enjoy a period of stability to enable it to recover. My noble friend Lord Pendry mentioned the sum of £20 million that was allocated last year to promote the tourist industry. That was very helpful indeed. Last year the Prime Minister appeared in an advertisement to promote Britain. After the events in Iraq he probably has Beckham cult status in the United States! I hope that the Prime Minister will take a lead in promoting this country in advertising. We need to get back international visitors.
	The infrastructure of the industry is also important. I declare an interest in that I chair the Freedom to Fly Coalition. That body tries to ensure that we have the aviation and infrastructure capacity to meet customer needs in the UK over the next 30 years. Two thirds of our visitors arrive by air. On the Continent air travel is recognised as an important part of the economy. Amsterdam Airport has expanded and has the potential to have six runways, although it does not have six at the moment. Charles de Gaulle Airport has expanded its capacity, as has Frankfurt Airport. Heathrow is no longer the No. 1 airport in Europe. It serves fewer destinations now than some of our European competitors. Our competitors are investing in new infrastructure as they want to attract this important industry. Our rail infrastructure is also very important in this regard.
	Like anything else, the industry is terribly competitive. It is also price-sensitive. It has recently carried out some work comparing itself with Europe on taxation. One example that it took was an American family of four coming to Britain. Tax accounted in the UK for 18 per cent of their spend, whereas in Europe the average was 12 per cent. One could say that, in the UK, the tax taken from the spend was 50 per cent more than the average taken in Europe. That could be looked at, certainly so that no more tax is put on an already heavily burdened industry.
	The debate is important to our economy and to jobs. At the moment the industry is seriously challenged, but it will come back. If we look at all the statistics, we can see that it will be buoyant. We have to do what we can to nurse it along, to make sure that it is ready to face its challenges and to take the opportunities raised by the noble Lord, Lord McNally, in trying to develop the domestic holiday industry.

Lord Patten: My Lords, I listened with interest and respect to the noble Lord, Lord Pendry, this afternoon, as I did over the years on many afternoons and evenings and, once or twice, during the now-vanished all-night sittings in those more heroic days when men were men down the corridor in another place and before we all became politically correct. Alas, I cannot wholeheartedly agree with his optimism of "A little more tourism, with a little more government help and intervention, will cure most economic ills", even though I greatly welcome the chance that he has given us in an excellent speech to debate the issues. I wish to concentrate on tourism in rural areas.
	I do not believe—I am so far the only dissenting voice—that tourism is some universal good. Sometimes at worst it encourages the "theme-parking" of Britain, and even the de facto destruction of that which tourists travel so far to go and see. Most of us enjoy going to look at something. However, sometimes the urge to become a tourist seems to be found in our growing national condition of rootlessness—the sense that the only way to enjoy the earth and the United Kingdom truly is to travel to places where one is not.
	Much of that rootlessness and dissatisfaction with where we are is because of the prior destruction of so many of our towns and cities, and their social, economic and built fabric, in post-war years. I applaud very much the thoughtful approach of the noble Lord, Lord Rogers of Riverside, and other noble Lords who wish to make urban life more desirable again—to make people wish to root themselves and recreate more at home, as people lucky enough to live in the country often do.
	After all, visitors to homes and houses, whether in town and city or the country, are often struck not only by the beauty of the architecture or the interior, but by the lingering sense to be found inside some such places of a calm that radiates from the making of a home by families and people who stayed put in the town and the countryside. One side of the coin of the generation of tourism is the fact that that cannot always easily be found by those who live in crowded urban conditions whom we have not served well since 1945.
	I intend to concentrate on rural areas, however, where local people do not think all the time that tourism is some blessing. Tourism can bring pollution, traffic congestion, overcrowding, and sometimes downright environmental damage. The income generated by tourists all too often does not stay in the local area but is siphoned off to other areas, so local people are not benefited.
	The countryside and those interested in rural tourism do not need more quangos, statist intervention, policies, campaigns, subsidies, or the invaluable ministerial time of Dr Kim Howells. I listened with great interest to the suggestion of the noble Baroness, Lady Dean of Thornton-le-Fylde, that the responsibility might be moved to the Department of Trade and Industry with its seven Ministers; that department is itself a sort of job-creation industry for Ministers. One of those Ministers could take on the responsibility if she feels that ministerial responsibility is not being exercised properly.

Baroness Dean of Thornton-le-Fylde: My Lords, nothing that I said or implied gave any indication that I felt that ministerial responsibility was not being expressed properly.

Lord Patten: My Lords, I accept that. I was not suggesting that it was the case. However, the noble Baroness was saying in the spirit of open debate that she felt that tourism might benefit from having a Minister in the Department of Trade and Industry—that that might be more appropriate, perhaps because Ministers there have more time. I welcome the chance to repeat that point.
	The countryside needs freedom, lightness of regulation, lack of interference, and the ability of a free market to develop genuinely local and sustainable tourist businesses. We need a bit more sensitivity and common sense from some of those involved in tourism already. I intend to concentrate on the National Farmers Union, the planners, the National Trust and, if time allows, national parks.
	First, I sometimes think that the great ones in the NFU privately believe we are seeing the beginning of the slow death of UK agriculture, following the end of much old-style manufacturing industry over the past 100 years. Those are exactly the points that the noble Baroness made in her excellent speech just now. Of course we see, even in lowland England close to the capital, plenty of stretches of unlovely countryside emerging, whether set aside or not, with the scattered remains of deserted sheds and stored machinery that are mute testimony to failed agri-businesses. We hear from the NFU, increasingly and bizarrely, that more tourism is the answer to the "crisis" in agriculture. What part of our national life does not have a crisis these days?
	Of course a bit more tourism will help in rural areas, and will help those involved in diversifying from agriculture. However, it is certainly not a solution to the problems. The line that the countryside will be revived by more and more tourism is complete tosh. What tourists in their right mind would wish to spend time, let alone money, visiting countryside that is running down because of failing agriculture? Only thriving upland and lowland agriculture can sustain and improve the beauties of our largely man-made and farming-sustained landscapes, which people wish to go and see.
	Secondly, I think that our planners in rural areas are so often bent on encouraging theme-park tourism, while getting in the way of truly local and organic attractions. I would like to give an example. If any noble Lords drive past Stonehenge on the A303, they will find it littered with what to me seem naff little brown signs, properly authorised by planners, suggesting that travellers might want to turn off and visit—I am not making this up—something called "Farmer Giles farmstead", a concept more at home in Las Vegas than rural Wiltshire.
	The same planners recently prevented the erection of a sign to turn off the same road and visit a wine merchant in a pretty little Wiltshire town. It is located in a beautiful ex-brewery building, and its owners have tried very hard to make it a visitor attraction growing organically out of the local community, with the possibility of picnicking in its pretty courtyard among the flowers and with a fountain. The planners decided that that is not to be—that it is not the sort of tourism that they want to encourage. They want to encourage Farmer Giles farmstead, with its plastic surroundings. I believe in the freedom of choice. If people want to visit Farmer Giles farmstead, that is fine by me. However, they should not be denied the chance to visit other, more local visitor attractions, such as the wine merchant to which I referred.
	Thirdly, the National Trust has been going through a very serious crisis over its corporate governance in recent years. Lord Blakenham's committee has come up with ideas on how to deal with the crisis, and his report lands in the lap of Sir William Proby, the new chairman, whom I wish well. The council needs to act very quickly on that, and must not delay for another year while the organisation continues to fight and fracture within itself.
	At the same time, an urgent look is needed at policy on the National Trust's own visitor attractions. Sometimes, they themselves are becoming alarmingly theme-parked. Sometimes houses in National Trust ownership have been sterilised and dehumanised, and that very sense of the house having been a home that visitors delight in has been progressively rubbed out. Elsewhere, new, politically correct interpretations by management have been overlaid on the literature and displays of the history of a place that does not deserve it. Visitors are then channelled out through the obligatory National Trust gift shop, which peddles goods that are sourced sometimes from hundreds of miles away and sometimes from abroad. Where is the local honey? Is that a silly point? No. It is a symbol of the total lack of understanding by the senior management of the National Trust. One of the best things that its top executives could do would be to have a policy to help local tourism in areas surrounding National Trust properties. The National Trust should have a "buy local first" policy, with nothing sold in its shops that is made more than 50 miles away. Let the money stay where it is spent.
	Why pick on the National Trust? It is the biggest landowner in England and Wales—I cannot speak with authority for Scotland. It owns more historic houses and landscapes than any medieval monarch would have dared dream of, let alone what any Whig magnate might have hoped for after a decent night around the table. It is in a mess. It desperately needs better, more understanding and sensitive executive management and leadership right at the top to deal with those issues, to stop it losing its way and behaving like the worst of the old nationalised industries.
	The national parks will have to wait until another day for my observations. While thanking the noble Lord, Lord Pendry, for introducing the debate, I conclude that tourism in rural areas will benefit from sensible light-touch measures, not from more government initiatives, more campaigns, more taxpayers' money and more statism. I hope that I am not alone in saying that.

Lord Palmer: My Lords, I, too, thank the noble Lord, Lord Pendry, for initiating this important debate. As I live in Scotland and own a tourist attraction, I intend to limit my few remarks to Scottish tourism, albeit that tourism is devolved. However, as the Motion is worded, we are concerned with the role that tourism plays within "the United Kingdom economy".
	The noble Baroness, Lady Dean, was right to say that so many of the tourist attractions in the United Kingdom are in the small business league. Many of them are owner-operated, the owners working long hours for little reward. I believe that the Government and all their tourism agencies must acknowledge that.
	I sincerely hope that somebody will send my old school friend, Sir William Proby, a copy of tonight's Hansard, so that he might read what the noble Lord, Lord Patten, said about his challenging new role.
	Tourism is one of Scotland's most important industries and arguably its most important indigenous industry, worth £340 billion worldwide. It is a growing industry, with forecasts of annual growth of 4.1 per cent until 2020. Tourism in Scotland injects almost £4 billion annually into the Scottish economy—that is, 5 per cent of GDP—and employs almost 200,000 people. Those 200,000 are employed right the way across Scotland, thus helping to try to maintain a sustainable rural infrastructure. For instance, in the Highlands and Islands region, 15 per cent of the working population are involved in tourism, which is nearly double the Scottish national average. In fact, tourism in Scotland employs more than the oil, gas and whisky industries combined and four times the number of people employed in agriculture and fisheries. It must not be forgotten that both of those industries are suffering from terrible trading conditions, which are totally outwith their control. Tourism might, in a small number of cases, be their vital lifeline for survival.
	VisitScotland, which is a non-departmental public body, funded by the Scottish Executive and fully accountable to the Scottish Parliament, has a strategic role in all of this. VisitScotland is the leading public sector tourism agency in Scotland whose role is to promote Scottish tourism in the UK and overseas and to provide leadership and direction for the development of Scottish tourism to help maximise economic benefit throughout Scotland. VisitScotland is doing its best to make Scotland a "must see" destination by marketing and promoting Scotland's many historical, natural, cultural and sporting assets. Seventy per cent of its funding is spent directly on marketing and promotion. It provides partial funding to area tourist boards and supports a range of niche market schemes. I must declare an interest as a member of the Scottish Borders Tourist Board.
	VisitScotland has played a key role in drawing up Tourism Framework for Action, which was published in March 2002 and which sets out opportunities and challenges facing the tourism industry. The TFFA is unique within the UK and I hope that, as a result, this will not be yet another national and costly layer of bureaucracy.
	In 2002, VisitScotland launched its new brand for Scotland, reflecting its built heritage, its traditions, its history, its culture, its fantastic scenery, its light, and—dare I say it—its weather and, last but not least, the friendliness of its people. Ninety per cent of visitors to Scotland come from the UK domestic market and VisitScotland therefore carries out a range of marketing activities across the whole of the UK. Particularly in these troubled times of terrorism and war, Scotland is less dependent on overseas markets, although it is trying hard to increase its share of international business. The USA, not surprisingly, is Scotland's largest overseas market, with an annual spend during the year ending 2001 of £201 million.
	There have been various attempts to introduce quality assurance schemes and now in Scotland more than 80 per cent of accommodation providers are members of a quality assurance scheme. That compares with only 50 per cent in England and 40 per cent in Wales. However, I am still doubtful about a grading scheme for visitor attractions, particularly for those such as the one that I own: a stately home set in beautiful gardens. Every stately home in the United Kingdom is obviously completely different. A few years ago, my home, Manderston, won the AA's bronze award. That award covered the whole of the UK. My family and staff were justifiably proud of this honour. Yet we were awarded only three stars under the VisitScotland quality assurance scheme against a possible maximum of five. I feel sure that that may in part be because we did not have a public convenience located around every corner.
	As I have already mentioned, funding for VisitScotland comes directly from the Scottish Executive. However, a proportion of VisitBritain's funding is spent on marketing Scotland overseas and VisitBritain is, of course, accountable to Westminster. Since the merger of the former BTA and the former ETC, there could now well be advantages to Scottish tourism, for example, and benefits from the overseas infrastructure of VisitBritain and its expertise in emerging markets.
	Many of us who live in Scotland and are involved in the tourism industry are concerned about the possibility of attention being focused on the marketing of England to the detriment of Scotland. I do hope that the Minister will be able to give his assurance to us today that Scotland will not be disadvantaged by the merger of the former BTA and ETC into VisitBritain and that Her Majesty's Government will continue actively to support the important activities of VisitBritain, which I believe, in turn, must do all it can to help to promote the UK as a number-one tourist attraction.

Lord Harrison: My Lords, as Hamlet himself might have said, contemplating the current plight of the tourism industry,
	"When sorrows come, they come not single spies,
	But in battalions":BSE, 9/11, FMD, WMD in Iraq and SARS—a veritable arsenal of acronyms which would blow up any industry other than tourism.
	I give just one example of the industry's travails. ABTA tells us that the annual pace of business failures among its membership has risen by 109 per cent, with a further 17 travel agents and four tour operators having gone under since last September. But they and the tourism industry as a whole are a resilient lot and will bounce back.
	One of the four lessons for the Government in their aim to help the industry to recover at a macroeconomic level is this: they must put in place contingency plans for tourism, much in the same way as they do now for farming and civil defence. Tourism is too important to be left to the vagaries of its next threat. Will my noble friend undertake to consider such emergency planning for tourism? I believe that we should contemplate it.
	Secondly, government must recognise that tourism is now a much more important industry than agriculture for the British Exchequer and that it reflects better the British way of life. Even the CLA concedes that rural tourism alone is worth £16 billion to the Treasury. It is time that British farmers conformed to the same demands of the market place as fall on tourism entrepreneurs in our towns and countryside. Better still, the two industries should work together for the benefit of all.
	Thirdly, the Government should embed the needs of the tourism industry in all their policy development and strategic objectives. Let us take the example of employment. Not only does tourism currently represent 7 per cent of Britain's workforce but it will provide even more jobs in the future, especially for women, ethnic minorities and school-leavers. Let us think about it, my Lords. Most of us took our first job as youngsters in the tourism or hospitality industry. We should count ourselves lucky that tourism provided the first footing on the employment ladder for so many of us.
	Fourthly, we should join the euro. Tourism is the industry that most stands to benefit from such a move. Perhaps the noble Lord, Lord Patten, should be reminded that the NFU also supports euro entry.
	But, lest I give the impression that hitherto the Government have treated tourism as if it were a foreign country, perhaps I may congratulate them on recent positive microeconomic measures and suggest some more. Incidentally, the restyling of the BTA/ETC as VisitBritain, with its additional powers to market England, is both rational and welcome.
	The Government's £20 million grant, matched by the private sector, for a recovery campaign in overseas markets, post-FMD and 9/11, is very sensible, as is the £10 million for the Enjoy England and European cities short break campaigns. I also commend the campaign in the USA to revitalise that market. After Iraq, we may hope for good support from our American allies. We want them, as visitors to Europe, to overstay in Britain and to be, indeed, overpaid and over here.
	But we can do more. The Government helped the industry through bad times by granting PAYE and VAT payment holidays for tourist firms in trouble. I ask the Minister whether those could be extended? Of all the industries, surely tourism is the one that deserves tax breaks and payment holidays. In the last Budget, the Government quelled the fears of the tourism industry that the air passenger duty tax might be increased. It was not. But how much better if it were abolished altogether. The £1 billion it raises for the Exchequer is, in effect, a tax on tourists coming to—yes—visit Britain. Moreover, by reducing VAT on accommodation nearer to the EU average of 8.5 per cent, we could provide real value for money for such visitors to Britain.
	Could the Government recognise more athletically not only the importance of sports tourism, so beloved of my colleague, my noble friend Lord Pendry, whom we congratulate on tabling this important debate tonight, but also the demands of business tourism? Help with the establishment, for example, of additional major international conference facilities in London and Cardiff would be a good start, but help for market towns such as Chester would also strengthen our ability to capture the valuable business market. In Chester we have an amphitheatre but not one large enough to entertain the legions of business tourists who would otherwise beat a path to Britain's best Roman and mediaeval city.
	And, á propos Britain's historic market towns—sequins in the tapestry of Britain's countryside—will the Minister support the excellent English Heritage campaign which seeks to equate VAT on all new build and repairs and maintenance to older buildings? Pevsner would turn in his grave now to discover that current VAT rules provide a perverse incentive to neglect the maintenance of such buildings and make otherwise unnecessary alterations to our built heritage.
	Britain's churches rightly enjoy a temporary exemption from these mad economics, while the sixth VAT directive is being remodelled in Brussels. But, in the meantime, can the Government help the others? In the presence of the right reverend Prelates the Bishops of London and Truro, perhaps I may also suggest that tourism and the churches have a common cause in increasing visitor numbers. Carefully done, might our churches seek to develop their potential, doubling up as tourist information centres? After all, those who pay to stay may also then stay to pray.
	But the tourism industry must also help itself. On a recent family holiday in England, staying at a sizeable modern hotel which had been built without a lift for hotel customers, we were appalled to see a disabled tourist having to be carried up and down the stairs by staff and friends alike. We badly need to encourage initiatives such as my own Cheshire County Council's "Tourism for All", which allows prospective visitors to gain on-line information about disabled-friendly hotels and attractions, thereby avoiding the indignities offered to the less physically able to which we were sad witnesses.
	On the other hand, I give an example of a good initiative which we discovered at the Ramada Jarvis Hotel in Norwich. There, management had had the gumption to allow an enlightened manageress to purchase oil paintings and watercolours commissioned from local artists to bedeck the hotel's public rooms and bedrooms. This second school of Norwich painting, successors to Crome and Cotman, stood in marked contrast to the dull prints which all too often adorn even the most expensive hotels' corridors. That was a local initiative which added local colour and made it a memorable holiday for me and my family.
	In conclusion, I should be grateful if the Minister could respond at the end of the debate or in writing to the several economic suggestions that I have made to help—I hope—tourism to bounce back to full and rude health.

The Lord Bishop of Truro: My Lords, I have the privilege and pleasure to work in what is without doubt one of the most beautiful parts of this country, and among the most visited by tourists. With the opening of the new National Maritime Museum in Falmouth as well as the Tate St Ives and of course the extraordinary Eden Project, which last year brought £111 million into Cornwall and, we are assured in a decade will bring in £2 billion, there is now an enormous growth in tourism in Cornwall, not only numerically but in the variety of attractions and interests offered. There is no doubt either that Cornwall has benefited from the changing patterns in the taking of holidays and that we have holidaymakers all year round rather than just in the summer months.
	All that is welcome, but there are real difficulties. Here, I agree with the noble Lord, Lord Patten. The first is the future pattern of agriculture and its place in Cornish life. Seventy-seven per cent of the Cornish landmass is agricultural land and, as most Members of this House will know, the pattern of agriculture there is very particular; indeed, unique. The fields are almost all small—sixteen acres is the average size—and they are surrounded by what are called euphemistically "Cornish hedges" which are made from a mixture of stone walls and earth. The roads that wind between them are almost all narrow, so much so that when I was recently taking round a Swedish bishop he asked in bewilderment whether we always drive in ditches in Cornwall.
	All this adds to the Cornish experience and no doubt is one of the reasons that people come to Cornwall. But the whole point is that Cornish agriculture is becoming more and more threatened. Small farms are being swallowed up and very often surplus farmhouses are quickly snapped up as second homes. Needless to say, local people do not get a look in because, despite the flourishing and diversifying tourist industry, Cornwall remains, we need to remember, the poorest county in England with significantly the lowest pay in the South West. Indeed, North Cornwall has recently been shown to be the most poorly paid part of England receiving £100 per week less than the national average.
	One of the problems about being a tourist area is that many of the jobs are poorly paid and despite the changing patterns of tourism, people feel that they are left out and being neglected. It remains the case that changing patterns have meant that the traditional Cornish industries of farming, fishing and mining, three ways-of-life industries which for many people are the reason they visit Cornwall, are fast disappearing.
	Tourism is a vital industry for all of us but there are important questions about the way it has affected Cornish life and how we can protect Cornish life and strengthen it so that tourists can continue to come and be refreshed by an experience of Cornwall which is both different and distinctive. Here, I agree with the comments of the noble Lord, Lord Patten. We stand a real risk of being overwhelmed and losing the most precious thing we have to offer in the field of tourism. I hope very much that the Minister can help us to see how we can deal with the particular problem with which we are faced. Finally, I ask that noble Lords on their next holiday come to Cornwall. Forget Devon and join us.

Viscount Falkland: My Lords, we are grateful to the noble Lord, Lord Pendry. I am particularly pleased to speak in tonight's debate. Over the past six years I have spoken in three or four debates on tourism and have become somewhat paranoid because I have presented views which have left me feeling rather alone. I am now on the side of the angels because a number of the points I made in those past debates, which made my contribution seem contentious, have been supported by no other than the Minister for Tourism, Dr Kim Howells.
	When thinking about this debate during the Recess I was interested to read in the Independent a very full coverage of the views of Dr Howells. Having disagreed almost entirely with all his views on the Licensing Bill, they were a great relief to me. I find it hard to reconcile what I thought would be his views towards tourism as a result of his views on the Licensing Bill with some of the things he has now said.
	I have always said that in this country we have an unparalleled range of attractions to offer our visitors. The only problem is that we have never sold them properly. I avoid the word "marketing". The noble Lord, Lord Pendry, mentioned marketing. In a way, we have over-marketed tourism in this country and relied too much on it. I compare it with something about which I do know, which is the preparation of feature films, their marketing and their sale. With feature films you have to develop the product until you have something which you decide is right for the market at which you are aiming. You then market it and sell it. The important part is getting the product right. Too often we have marketed tourism in a way which has been very good but has become separated from the nature of the product and the value of that product to customers as the customers changes. That is one of the problems in tourism today.
	Dr Howells asks, "Why can't we be more like the Germans?". There seems to be a curious pro-German sentiment going through the Department of Trade—a Freudian slip—the Department for Media, Culture and Sport, entirely due to the noble Baroness, Lady Dean. Indeed, Tessa Jowell praised the Germans for the way in which they treat the arts. We now have Dr Howells praising the Germans for the way they operate as tourists, with which I agree. The Germans spend much time travelling in Germany as well as travelling abroad, as has been mentioned by other noble Lords, but so do the French, the Italians and the Spanish. That is quite normal. However, most of those countries have six weeks or more of holiday per year, which makes a difference. The average holiday in this country, particularly among people who tend to go on package tours, is very seldom more than four weeks and often less. That makes it very difficult. Most people want to go to the sun; I do not know why. After all, we have global warming. The sun is very bad for us. The English countryside and the English weather go very well together and form a perfect backdrop to the excellent heritage sites that we have on offer.
	The untouched beauties of the British countryside are there for all to see. During the Easter Recess I travelled not far from London along the South Downs because I am keen on racing, though not as keen as I used to be. I tend to go by motor transport through the lanes and byways. Taking a line from Cheltenham to Bath, Salisbury and Newbury down to Brighton, you will pass through some of the most beautiful country in England, although people are somewhat sniffy about the Home Counties. You will still find the most beautiful villages, towns and countryside almost untouched by tourism.
	I was amazed, during that fine weather, at the beautiful little villages between Farnham and Guildford, beautifully kept, which seemed to be completely unvisited by tourists. What is happening is that our own people are not visiting these places. Foreign visitors visit these places only if they are adventurous and go under their own steam and, as it were, go on a kind of adventure holiday to find out the hidden secrets.
	The Minister, Dr Howells, quite rightly says that we must tempt more Britons to stay at home and visit their own country rather than go abroad. That is more easily said than done. Apart from the weather, which I have just mentioned, it is a curious characteristic—and I noticed it again on my visits during the Easter period—that our own compatriots tend not to go, unless there is a very good reason, off the major roads and byways. One often sees people in England eating sandwiches in their cars close to a major road or motorway. In France or Italy, one sees people in the depth of a forest with a small table and camp chairs and a delicious meal which they have prepared and taken with them. This is a cultural difference. It is not something which Dr Howells, or anyone else, will change very quickly; although, I admire his sentiments in desiring that to happen.
	I understand that Dr Howells has already put £4 million into an effort to persuade people to visit our own countryside and our attractions. A great deal more than that will be needed to change those cultural habits, but I praise him for that effort. It is important to develop our home tourism so that we can find out what is wrong with it in order to attract foreign tourists here, not only to visit our attractions once but to return again and again. Currently, that does not happen. We know the reasons why. I do not have the time, nor do I wish to go into the obvious reasons; the difficulties of travel, the high prices in restaurants and the high prices of hotels, which I have mentioned in previous debates. We have not got to grips with these problems.
	Apart from the Michelin Guide, there is not a decent reliable guide in this country that I can find. There are various guides with reliable parts. But we have nothing to compare with guides that are available in other European countries, which tell people where to find good value, how to get to these places and what to look for. We have already had a debate in this House about websites in Britain. They are ludicrous. I drew your Lordships' attention to one website. Its first remarks were, "Don't come to this place. The traffic is so awful. Go somewhere else". Unless we change our mentality regarding attracting customers and selling what we have, we shall be in difficulty for some time.
	I keep wanting to call Dr Howells "the noble Lord"—perhaps he will end up here. He talks about "gateway packages". I think that is a great idea. He has been accused by some in the travel industry of having crazy ideas about the issues to which I have referred. However, what could be crazier than the Budd committee's idea that the seaside resorts of this country will be resuscitated and restored by putting in casinos. That is madness. We all know what casinos at the lower level do. They are not charming places. They are turning full circle to where in the old entertainment arcades the fruit machine had its birth. If the proposal is carried through, I predict that we shall witness an unattractive and tacky attempt to restore seaside resorts, which—and this is a personal view—will end in disaster. The Departure for Culture, Media and Sport now has about 18 civil servants working on how the Budd report will translate itself into gambling deregulation, attracting tourists and so on. I hope that this proposal will rot on the vine.
	Various interesting points have been made and I hope that other debates will follow. The noble Lord, Lord Pendry, introduced the important point of the arts. Yesterday I was at the National Gallery where I had a luncheon appointment. I went an hour early. I am one of those people whom, for some reason—perhaps it is because I look English or that I will not knock them over—people tend to ask for directions or for guidance. I get into conversations with people. I am absolutely convinced that there is a large group of people from abroad who come to London expressly to visit the major galleries and museums—the Tate, the National Gallery and so on.
	I saw large numbers of people. I talked to a Danish tourist yesterday. It was his second visit. He has come here for a week expressly to visit these major galleries. The National Gallery is a wonder, as is the National Portrait Gallery and the Tate. Today's Evening Standard states that even in New York we are now recognised as being the centre of the arts. So we must recognise that in London we have not only Buckingham Palace and the changing of the guards, but we have an unequalled attraction. We must get people over here to visit the cities and to go out into the countryside, as Dr Howells suggests.
	My time is running short and I shall not run over it, but I end the debate on a low note. The noble Lord, Lord Palmer, mentioned public conveniences. There are none in the places where they are needed. We are an ageing population and we have many ageing tourists. I read in the Independent that in London 24 Portaloos have to be brought in at weekends to satisfy demand in Westminster. I do not know why we have not restored those fine old Victorian public conveniences. It is no wonder that everyone uses the streets, the monuments, the railings and the pavements, with all the distress and problems that that causes. That is just one issue that should be targeted in the cities. We should bring back public conveniences. They are a natural facility that should exist.
	This has been an interesting debate. Now that a new tone has been set by the Minister for Tourism, Film and Broadcasting, I hope that we shall have many more debates so that we can explore many of the ideas that have been raised.

Baroness Buscombe: My Lords, I thank the noble Lord, Lord Pendry, for introducing this important and timely debate.
	Tourism is the fifth largest industry in England and the largest industry in Scotland and Wales. It generates about 4.5 per cent of total United Kingdom GDP and ranks seventh in the international tourism league. Furthermore, the multiplier effect indicates that it is not just the industry itself that benefits from tourists visiting the UK; many other service industries, such as shops, restaurants and taxis, rely on the income generated. For every £100 spent in tourism, another £50 goes to other industries. The significance of this industry to our economy can therefore not be ignored. Tourism within this country must be encouraged to grow and prosper.
	As the noble Lord, Lord Pendry, said, tourism should be high on the Government's agenda. The noble Lord, Lord McNally, referred to tourism as being a "Whitehall orphan". I must say that when I took on the brief for culture, media and sport, of course first there was no mention of tourism; and, secondly, I thought to myself, why is such a major industry not under the umbrella of the DTI? It certainly is not necessarily Conservative policy that it should be moved to the DTI, but I think that questions should be asked. I know that many people in the tourism industry feel that they are in many ways the poor relation.
	I must point out to the noble Baroness, Lady Dean of Thornton-le-Fylde, that it is not the Minister, Kim Howells, but we in this House who are busy on the Bill dealing with Ofcom. He is busy in the Commons turning over all the many good changes that we achieved on the Licensing Bill. An important point that should be made is that it is tough that Ministers—and may I say Shadow Ministers—spend so much time dealing with legislation when there is so much that concerns our various briefs. We should be out there more. How we reconcile the two is hard to achieve.
	Regulation of the tourism industry has undergone considerable change in the past five years. In 1999 the Government abolished the English Tourist Board and replaced it with the English Tourism Council, consequently devolving the marketing function to individual regions. We believe that removing the marketing function from the English Tourism Council has been detrimental to the industry's prolonged prosperity. I agree with my noble friend Lord Montagu of Beaulieu who said that this led to a fragmentation of efforts. He should know with his in-depth practical experience of the industry. I think we should applaud the noble Lord for having made his first speech on this subject 50 years ago.
	The Government announced last year that the English Tourism Council and the British Tourist Authority were to merge to form VisitBritain. That new body is responsible for marketing both England and the UK as tourist destinations. We fear that that merger will result in an internal conflict of interest within the new body, which is charged with the marketing functions of both England and the UK. Approximately 15 percent of British tourism benefits from the activities of specific organisations which promote parts of the UK outside England. Will the Minister clarify what measures the Government have adopted to ensure that the potential internal conflicts of interest faced by VisitBritain will be prevented?
	In January this year, the Select Committee on Culture, Media and Sport published a report entitled The Structure and Strategy for Supporting Tourism. The report raised serious concerns about the sustainability and funding of the tourism industry. The primary concern raised was that of recovery following the outbreak of foot and mouth disease and September 11th. The committee reiterated our concerns that tourism should be placed high on the agenda and repeated our conclusion that the support structure provided in response to that crisis was grossly inadequate.
	In August last year, an article in the Independent claimed that the decision to show a photo of Tony Blair in a yellow protective suit cost Britain approximately £1 billion in lost revenue. The industry cannot afford to tolerate such an unnecessary oversight.
	Furthermore, as has already been said, the effects of September 11th continue to impact adversely on the tourism industry. Iraq, and now the SARS virus, bringing additional fears of flying, thereby affecting inbound tourists, have compounded that challenge.
	In agreeing with the Select Committee report, we believe that the Government's response to this crisis has been to adopt a laissez faire approach. For such a fragmented industry to survive, a strong and supportive infrastructure is imperative. The Government have systematically failed to provide a sustained increase in investment for tourism for Britain as a whole and, in particular, England.
	Scotland and Wales have been granted massive increases in funding from the devolved administrations, while England's grant-in-aid was cut repeatedly prior to the ETC being folded into the BTA. The British Tourist Authority's grant-in-aid has remained static for years with the exception of the "Only in Britain, Only in 2002" campaign last year, which generated an extra 1 million visitors. That kind of extra investment should be placed on a stable footing.
	Furthermore, the alarming disparities in the funding of the three tourist boards prior to the establishment of VisitBritain cannot be justified. The Scottish Tourist Board received £19.4 million, the Welsh Tourist Board received £15.4 million but the English Tourism Council received only £11.7 million. Indeed the Select Committee recognised that inconsistency and in comparing the figures stated:
	"These figures leave no doubt that there has been a sustained problem of under-investment by the public sector in tourism that has affected English Tourism in particular. It has long been recognised—in principle—that the special characteristics of tourism and its revenue generating potential justified specific public sector support".
	The Government have repeatedly talked about sustained, increased investment across the board in the public sector. In the tourism industry, there have been repeated Government reforms without sustained investment and without a successful solution. It is time for the Government to make a commitment to long-term and sustainable growth.
	The new body, VisitBritain, on behalf of English tourism, will continue to receive the same level of funding this year as the English Tourism Council. However, £3.6 million will be channelled to regional tourist boards via the regional development agencies. The Government's move to shift the funding for tourism at the regional level through the RDAs is, at best, a mixed blessing. Success now depends on a close working relationship between VisitBritain and the regional tourist boards. At present, that is not always the case.
	Now that the new organisation is in place, we must do all we can to support and encourage its development. Although we welcome the aim behind the Government's new structural changes, we have reservations about whether the measures proposed will deliver the improvements for tourism that the Government seek. Key issues will affect the success or otherwise of that new move. Effective distribution of information is essential—that is equally applicable to domestic visitors as to international tourists.
	The English Tourism Council and now VisitBritain have ensured that the key tourist information centres have a better support network than ever before. Those information centres are effectively the front line of UK tourism. For example, last year the Britain and London Visitor Centre on Regent's Street dealt with enquiries from more than 500,000 people.
	That said, I think that many would agree that it often remains difficult to book a hotel or a package holiday at home. We urge VisitBritain to make an on-line booking site a priority. Such a resource is urgently needed to boost our domestic industry and encourage the British to holiday in this country.
	VisitBritain has arranged a "Royal Tourism Day" on 10th June. The Royal Family will spend the day visiting different parts of the UK to highlight excellence in British tourism. However, I can already hear cries of confusion with people asking: "Why is the website entitled visitengland.com when the new body is called VisitBritain?" We must make it as straightforward as possible for both the domestic market and overseas visitors to enjoy so many of our worthwhile attractions.
	The Bradford Industrial Museum provides an excellent example. The museum is based at Moorside Mills in Bradford, which used to process raw wool into best cloth. It is now a flourishing attraction where visitors can experience the sounds and smells of engines that once powered the mills throughout Yorkshire. At the attraction, one can see all the old processes at work, including shire horses. It has also joined with the local authority, the Science Museum, the Heritage Lottery Fund and others to purchase working vintage buses from the 1930s, 1940s and 1950s for free vintage bus rides.
	Nearby attractions include the National Museum of Photography, Film and Television—its current excellent exhibition, "Fabula", brings together a group of young and emerging artists from the UK, France, Germany, Israel and the United States, and has received great reviews. Both attractions show the potential benefit of having a diverse, original tourism product to regenerate an area that has passed its industrial prime. On the arts, I agree with the noble Viscount, Lord Falkland, that the major galleries in London, such as the National Gallery and the National Portrait Gallery, and our museums, such as the British Museum, are definitely attracting visitors.
	Visitors to Britain come here for different reasons. I was especially interested in the perspective offered by the right reverend Prelate the Bishop of London—that our religious buildings act as a magnet, bringing great economic advantage. The noble Lord, Lord Palmer, referred to our stately homes. Our historic houses are an enormously important attraction to Britain and focused marketing is therefore key.
	Promotion of the many attractions that we offer is key, alongside the provision of tourist information. Our rural communities contain a wealth of attractions, and promotion of them can be achieved in different ways. For example, Britain once had a terrible reputation for food. We now have every reason to proclaim Britain as a nation of food lovers and producers of wonderful, varied food. That translates into promotion for our rural communities, with their wealth of restaurants, hotels and bed and breakfasts.
	Padstow in Cornwall has in recent years been transformed—first by one dynamic and enthusiastic foodie, Rick Stein, and then by others who have taken advantage of his success and opened more restaurants, retail outlets and visitor attractions.
	I listened with care to what my noble friend Lord Patten and the right reverend Prelate the Bishop of Truro said. Tourism can be a mixed blessing, especially for those who live in the area all the time—the locals. As the right reverend Prelate suggested, there is a risk of being overwhelmed and losing the very thing that we need: tourism. Yes, theme parks can be a turn-off, but in contrast, projects such as the Eden Project in Cornwall should be applauded.
	In conclusion, I agree with my noble friend Lord Montagu of Beaulieu: tourism is one of our few industries capable of making a massive contribution to Britain in so many ways. I am glad that we have had this debate, which has given your Lordships the chance to put pressure on the Government to support this vital resource for our economy.

Lord Davies of Oldham: My Lords, the House is grateful for the opportunity provided by my noble friend Lord Pendry to draw attention to the vital importance of tourism for Britain's economy. I congratulate him on his speech, which raised most of the issues that we must consider, and also on his work on tourism over many years in both Houses, which enables him to bring real insights to the issues from which we have benefited today.
	The centrality of a vibrant tourism industry to our national life is something to which my noble friend first drew attention in Breaking New Ground, a document that formed the Government's view on tourism and led to the publication of our first ever tourism strategy, Tomorrow's Tourism, in February 1999. The House will recognise that his commitment to the industry is matched by that of the noble Lord, Lord Montagu, who exceeds him in longevity in the field. We recognise that the noble Lord, Lord Montagu, has had expertise of these topics for a long time. We are extremely grateful to two powerful speakers for launching the debate.
	There is no doubting the huge role that tourism plays, not only in the economic life of this country, but also in its social and cultural life. Britain is the sixth most popular tourist destination in the world. In 2001, tourism contributed £74 billion to the national economy. There are 2.1 million people directly employed in tourism—around 7 per cent of employees in Great Britain. Since 1992, tourism has been responsible for one in six new jobs. That subject formed the burden of the remarks of my noble friend Lady Dean, who indicated how crucial the industry was to the economy.
	I note the noble Baroness's suggestion that it might be beneficial and more accurate to locate responsibility for tourism in the Department of Trade and Industry. On this occasion, I shall resist that suggestion and stay loyal to the department that I represent today. We believe that we are meeting the challenges of tourism. I recognise that the challenges are acute—not just that tourism is a significant part of the economy, but that it is predominantly arranged in small components and small industrial enterprises mostly thought to be given effective government support. That is why some issues of tourism support are perhaps more difficult than those in any other industry that runs into crisis.
	The tourism sector is most prone to crises that are difficult to forecast or to respond to in the short term. Several noble Lords reflected on the devastating year of 2001 when foot and mouth disease caused enormous damage to our agriculture. But we all recognised when those points were made that the outbreak had a similarly devastating effect on our tourism industry. Much of our attractive countryside was out of bounds to visitors during that period.
	September 11th matched and outweighed the previous crisis affecting travel from the United States—the Lockerbie bombing. The travelling public in the United States are unusually sensitive to the threat of outrageous acts causing death and destruction. Although such acts may dominate the media for a relatively short period, unfortunately their reverberations in the tourism industry can continue for years afterwards. It took us many years to recover our trade from the United States after Lockerbie.
	We are still sustaining the effect of the devastating anxieties produced in American society as a result of September 11th. Inevitably, the war in Iraq contributes to that aspect. Although the medical profession will identify that the present threat of SARS in this country looks very muted, and although the outbreak of that frightening disease will probably cause limited numbers of deaths across the globe, the uncertainty of the situation and its impact will mostly affect tourism. We pay the price, even though objectively the risk involved may be limited. That is the nature of the tourism industry.
	I say to my noble friend Lord Harrison that we have sought to learn lessons from such disasters. They are not easily overcome. It is not easy to rebuild confidence after it has been shattered through events over which none of us has any control. I assure him and the House that the tourism industry emergency response group set up after the September 11th horror has made detailed contingency arrangements to respond quickly to any challenges that the industry might face in future. That does not mean that the response can always be dramatically and immediately successful. But I assure the House that we recognise the importance of having machinery to try to absorb the shocks of such unforeseen events.
	It is vital that we market England to the domestic audience, which, after all, is our largest and most robust market. Secondly, it is important to establish a single voice for the industry, which we have now created. It is important that the industry can respond quickly to such events and make the most of new opportunities as they arise.
	Following the creation of the tourism alliance in September 2002, the Government and industry developed the million visitor marketing campaign. That unprecedented partnership contributed to recovery compared to the same period in the difficult year of 2001. An additional 1.64 million visits to the UK were made in 2002. It also provided a model for the long-term future of Britain's tourism industry.
	We have built on that model with an ambitious plan for a new framework for tourism. The main elements are the launch on 1st April of VisitBritain, as several noble Lords recognised, which is a lead body combining the strength and skills of the British Tourist Authority and the English Tourism Council. Its remit is to promote inbound tourism and to market English tourism to a domestic audience. There will be an increased role for regional development agencies in England in providing strategic leadership for tourism. In addition, there will be a closer engagement of private industry in partnerships at all levels and proactive industry sponsorship by the DCMS.
	We are concerned that initiatives to improve skills and training should continue. There should also be a fresh look at accommodation quality assurance schemes. I accept the point made by the noble Baroness, Lady Buscombe, that we might also consider the creation of a web site to market effective accommodation. There is no doubt that, in the more distant past, British tourism suffered from a general reputation of having a less-than-successful strategy for ensuring that accommodation was up to standard. Improvements, which are appreciated in many parts, have taken place in recent years. But we must communicate that effectively and improve our marketing in that regard.
	The benefits of the new structures of VisitBritain will ensure that England receives an excellent marketing service, co-ordinated at national and regional level to remove duplication and to make the most of the collective effort of all sectors promoting tourism here. The tourism industry in England will now have a single point of contact at national level for the promotion of England at home and overseas, and for information about tourism in England and the rest of Britain. The noble Lord, Lord Palmer, advocated powerfully the case for Scotland. I emphasise that Scotland's case is duly recognised. VisitBritain's role in promoting the whole of Britain overseas is not affected by its new remit to market England domestically. VisitBritain will, of course, be the focal point for ensuring that we tap into and continue to expand the market for England, Wales, Northern Ireland and Scotland for visitors from overseas. It will ensure that strong and separate brand identities for England, Scotland and Wales are retained and developed, while encouraging a more coherent marketing agenda throughout Britain.
	A good deal of support, spending and promotion for the development of the tourism industry has always been done at regional level. In the regions of England, DCMS has devolved responsibility for the delivery of tourism strategies to the regional development agencies, with the aim of embedding tourism deeply into regional economic development strategy and to ensure that policy and product development is relevant and deliverable. That is essential because, as several speakers emphasised, different parts of the country have different selling points, different attractions and different support needs.
	I recognise the point made by the right reverend Prelate the Bishop of Truro, which was also made by the noble Lord, Lord Patten, that tourism may not be an unalloyed boon to a particular area. There should always be a balance between, on the one hand, the needs of local communities and the people who live there and, on the other, the needs of the tourists. It is important that we recognise that particular parts of the country can suffer dreadful privations from the onslaught of tourists in certain months of the year. Cornwall stands out as an example of that, although it is also true that the economy of Cornwall is crucially dependent on successful tourism, given the limited economic opportunities in the county. A balance must be struck, and the marketing must be effective.
	The Government are aware that approximately 70 per cent of in-bound visitors to the UK come through London. The value of tourism must be spread throughout the regions, and that is one of the Government's key priorities. We recognise and take pride in the enormous range of attractions with which London presents the visitor. We are well aware that, when we market the delights of Britain abroad, London is bound to feature hugely. I am grateful to the right reverend Prelate the Bishop of London for emphasising that fact this evening. It is also the case, of course, that we want London to be the gateway for tourists to enjoy other parts of Britain, rather than being the sole port of call before they move on to another capital offering similar but lesser delights. The country of Britain can offer a different experience to that offered by London, and it can be greatly rewarding.
	The private sector will play a key role in the new arrangements, helping to set the marketing agenda. It will work in co-ordination with VisitBritain to promote a coherent message about what the nations and regions of Britain have to offer. There will be campaigns funded jointly by industry, regional and local government and VisitBritain. We see so much duplication of effort and so many mixed messages. The trick is to get industry, regional government and VisitBritain to make a concerted effort to get the most for Britain, the tourism industry and the wider economy.
	The noble Lord, Lord Montagu of Beaulieu, mentioned the level of direct government funding to the industry. He was slightly more generous than his Front Bench colleague in recognising the contribution made by government funding. To the noble Baroness, Lady Buscombe, who put her comments about government funding in a more astringent and critical form, I say that, of course, we would like to see more money spent. The noble Baroness will recognise that we are committed to spending £10 million more on tourism. DCMS provides £50 million of direct government funding a year, and, on top of that, the Government pledge hundreds of millions of pounds in support of the arts, sports and galleries, which, as noble Lords recognised, are of benefit to tourism. I am grateful to the noble Viscount, Lord Falkland, who was most emphatic about the importance of our national museums and art galleries to our appeal to tourists.
	I take the noble Baroness's criticism in the spirit in which it is intended—as an attempt to increase the budget for my department. I look forward to its being reflected in the Chancellor's distribution next year. However, I counsel the House to recognise that, although it is easy for the Opposition to call for more money to be spent, it is more difficult for them to square that with their commitment to a 20 per cent reduction in overall public support for all aspects of British national life. I leave the noble Baroness to wrestle with that issue on another occasion.
	As the right reverend Prelate the Bishop of London stressed, churches and cathedrals are a vital part of our cultural heritage. A Force for Our Future, published in December 2001, recognised the important links between tourism and heritage sites. Westminster Abbey is one of London's premier attractions as well as being a UNESCO world heritage site. I recognise the point that the right reverend Prelate made about the costs borne by the Church authorities that are not related to the purpose for which the churches are there but are occasioned by the use to which tourists put the buildings. I assure the right reverend Prelate that the department intends to meet the Church Commissioners and members of the Archbishops' Council this summer to discuss a broad sweep of issues relating to ecclesiastical heritage. I have not the slightest doubt that, at those meetings, the right reverend Prelate's voice will be appropriately and significantly heard.
	We must increase the productivity and competitiveness of the tourism industry. We are aware of the success of some aspects of the German tourism industry, to which reference has been made. There is room for improvement in the way in which we organise some of our facilities in the United Kingdom. That is why we are concerned to have a proactive tourism industry sponsorship agenda, aimed at improving the effectiveness of the industry. The aim is to develop a competitive and sustainable tourism industry. We must enhance the skills of our people in that respect, but we should not sell ourselves short. For instance, we should recognise that, although the French are good at emphasising that they are the culinary leaders of the world, lists of top restaurants show that the greatest concentration is in the United Kingdom. We should not get caught up in age-old stereotypes about success, and we should pay due regard to what we have in this country. We should enhance our skill levels, our performance and what we offer tourists. We should blow our own trumpet more vigorously than in the recent past.
	Reference has been made to Lord Kim and Mr Kim: Dr Kim Howells is the Minister for Tourism in the Commons. Of course he is busy with legislation; all Ministers lead a busy life. However, Ministers are aware that legislation is one dimension of the job and that the work they do outside Parliament is another. Dr Howells is extremely vigorous in promoting tourism. Only last week, he launched the campaign to market England—"Enjoy England"—with the help of television advertisements. It is the first time for a long time that there have been advertisements on television specifically directed towards marketing England. I have no doubt that they will have a beneficial effect. The campaign that my honourable friend has launched is a unique partnership with a value of approximately £4 million and brings together, for the first time, regional development agencies, VisitBritain and the private sector. I have not the slightest doubt that that campaign will bring considerable benefits.
	In this respect, I emphasise that there are a whole range of issues on which we focused today in a somewhat critical vein. But there are areas on which we should congratulate ourselves for making progress. The noble Lord, Lord McNally, emphasised that there are areas of Britain, in terms of attractiveness, to which we have not paid significant regard in the past. I welcome his contribution and that of my noble friend, Lord Pendry, that we need to look at the issue of resorts and the way in which we can enhance their attractiveness so that more people stay at home to enjoy the benefits of Britain.
	The noble Viscount, Lord Falkland, raised his concerns about the issue of casinos and whether they would bring benefits to seaside resorts. I am not sure that he would say that if he were in Monaco now, nor am I suggesting that we could—or would even want to—replicate that level of casino industry here. But there are a number of our seaside resorts which would not mind just a tiny fraction of the resources which come within that framework, which is almost totally based on casinos. Therefore, I am not prepared to accept that criticism too fully.
	In conclusion, I want to emphasise that we live in a country which is uniquely well placed to attract tourists and we attract them in very large numbers. Of course, we could do better. But we all recognise that we have historic cities, beautiful countryside, great stately homes, a wonderful coastline, internationally renowned sporting events and facilities, world-class museums and galleries. They all need to be marketed to people who would benefit enormously from visiting this country and taking advantage of what it has to offer. Very few countries can compare with the range which we have to offer.
	I recognise that there are areas in which we can do better. However, I have not the slightest doubt that the VisitBritain campaign, which is setting out in a co-ordinated way to market the glories of this country for the benefit of potential visitors—of course, in the long term to the benefit of ourselves too—will be successful. It is on that basis that I conclude this debate on an optimistic note.

Lord Pendry: My Lords, I am grateful to all those who took part in this debate and made a real contribution by advancing positive ways to improve the position of tourism and hospitality in the United Kingdom. I enjoyed the remarks made by the noble Lord, Lord Montagu. However, I must chide him that, as president of the Broadstairs Society, it took me, a lay member of that society, to praise the seaside resort of Broadstairs, where I was born. Perhaps it was right that I should do that and not necessarily the noble Lord.
	The noble Lord, Lord McNally, always makes a powerful speech on tourism and he did so again today. I thank him for his recognition of the importance of the document that I wrote entitled Breaking New Ground and, in particular, his comment that it was not heavily party political. I am sure that he says that with real conviction because the Liberal Democrats pinched much of it.
	The right reverend Prelate the Bishop of London raised an interesting aspect of the link between religion and tourism. It is one that I have not heard in parliamentary debates in the past, but I hope that it will not be the last time. My noble friend Lady Dean made a very thoughtful speech, as one always expects of her. I would argue with her on one aspect, although I agree with her that tourism is too lowly down the Whitehall chain. I disagree that it should be with the Department of Trade and Industry. I shall not go into it now but my noble friend knows that I believe that there should be a new department for sport and tourism which would link together well.
	I do not know about the noble Lord, Lord Patten, but I am not so sure that I have completely recovered from those late-night sittings in another place in the 1980s and early 1990s. However, he seems to be fit and well. Some of the points he made about the rural economy and the National Trust are interesting. Many of his comments were controversial and I would not entirely agree. But he made his speech with his usual charisma and style—and that is as far as I shall go.
	The noble Lord, Lord Palmer, made a powerful plea for Scottish tourism. I, too, praise the role of VisitScotland and I concur with what is being done. I am sure that it will hear what he said. I have listened to my noble friend Lord Harrison on many occasions—for example, when he was an MEP—battling away for tourism. Tonight is no exception and I am sure that the House will hear him on many occasions.
	I shall pass on the kind words of the noble Viscount, Lord Falkland, to the Minister for Tourism. I am sure that he will appreciate the rather preferable remarks from that direction than came from the noble Lord, Lord McNally. However, I am sure that the noble Lord, Lord McNally, was just having a little "Lord McNally". It is true that I mentioned marketing, but when the noble Lord reads the Official Report tomorrow he will find that I said that it was not the complete answer. I think that he implied that I thought that it was rather more important than I said.
	What can I say about the noble Baroness, Lady Buscombe? I am a great admirer of her on the Front Bench. She does a tremendous job and I shall not go into the issues with which I disagree. But there was so much that she said which agreed with my speech that I could hardly have a real go at her. Therefore, I shall not be over-critical. Many of her comments were thoughtful and helpful. As chairman of the all-party sports group, one of its great achievements is that we find we have much more in common than not. Some of that has come though in this debate.
	Finally, I thank the Minister for his helpful speech. I am confident that he will ensure that his department takes note of the issues raised in this debate. It is to be hoped that the department will consider and act upon those matters which have been made in such a constructive way. Although there was not a packed Chamber to listen to the words of wisdom from noble Lords, I believe that those in the tourism world will know that there are a number of people in this House who are their friends and are prepared to fight their corner from time to time.
	With those words, I beg leave to withdraw the Motion for Papers.

Motion for Papers, by leave, withdrawn.

MRSA in Hospitals

Lord Ashley of Stoke: rose to ask Her Majesty's Government whether they have any new proposals for dealing with methicillin resistant staphylococcus aureus (MRSA) in hospitals.
	My Lords, I welcome the opportunity to debate the menacing growth of methicillin resistant staphylococcus aureus, commonly known as MRSA, in our hospitals, and indeed outside them. I hope that my noble friend Lady Andrews will be able to explain what the Government are doing and answer some perplexing questions.
	First, the Government have made commendable advances in tackling these problems—in particular, their introduction of mandatory reporting, the setting of standards for hospital trusts, the introduction of guidelines and the return of matrons. These are all welcome steps, among others, to which my noble friend will no doubt refer.
	But are they enough? I doubt it very much indeed. If we look at some of the plethora of figures and, in particular, the trend, we find them disturbing. The first recorded cases of MRSA in the UK were in 1992—there were 104 cases. In 2001, there were nearly 5,000 cases—4,904 to be exact. Last year, the figure was 7,000 cases in England and Wales, which compares badly with the early years. Therefore, it is a growing menace, and not just numerically because new strains have been reported in the United States. One strain in particular has hit thousands of fit, young Americans with no links to hospitals. If, as is possible, those bacteria come here, it complicates our problems even more.
	We know that the most vulnerable are feeble, older people whose immune systems have been weakened and who may have been prescribed too many antibiotics. We know also that dirty hospitals contribute to the bacteria. At least, we thought we knew that. Now Ministers are saying that there is no strict relationship between hospital cleanliness and MRSA, although it is an important consideration.
	Where do we stand? To complicate matters further, Paul Burstow, MP, who has a fine record on this subject, found in a recent study that two-thirds of hospitals with the worst records for controlling MRSA infection had won the highest "green light" rating for cleanliness. That is a puzzle.
	No one is going to advocate dirty hospitals, but if clean hospitals have a poor record on MRSA, just what can they do? To what extent are their infection control systems effective? If they are not effective, what is wrong with them? Is it technique, training, lack of money or failure of will? We need urgent answers to these questions if we are to make any real progress. We need to know whether hygiene is related to MRSA. It would seem to be a straightforward question with an obvious answer, but in view of ministerial statements that there is no strict relationship between hospital cleanliness and MRSA, we need to know from the Government whether it is factor, and if so, to what extent. If it is, then it is right to devote more resources and effort to improving hygiene, but if there is no relationship, then hospital hygiene, although important for other reasons, can be discounted in relation to MRSA and other issues demanding greater attention. What is the Government's judgment on this?
	If hygiene is a factor—I would be astonished if it is not—then the present haphazard methods and approach have to end, and quickly. Press, radio and television repeatedly provide examples of unwashed hands, dirty toilets and showers, and a failure to wear gloves. Doctors, nurses, cleaners and patients themselves must wake up to the cleanliness challenge. Constant posters should be on hospital walls proclaiming, "Wash Your Hands", as happens in my local Epsom Hospital.
	Infection control lies at the very heart of any attempt to cope with MRSA. I know that the Government have allocated cash for this, but to what extent is it being systematically monitored? The general shortage of hospital beds creates great difficulties, but all patients with MRSA should be removed from the wards and isolated. This does not happen at present because of the bed shortage, but a room or bed that has had an MRSA patient should be properly sterilised before the arrival of the next patient. What is the Government's view of the high level of bed occupancy in relation to MRSA? Many hospitals are full to capacity.
	Overall, what is the Government's assessment of this major battle between bacteria and antibiotics, the outcome of which will have profound and far-reaching consequences not just for this country, but for mankind? Are the bacteria winning? If we reach the stage where antibiotics cannot cope with new strains of bacteria, we are all back in the pre-antibiotic period. The House of Lords Select Committee on Science and Technology, in its admirable report published in 2001 on resistance to antibiotics, stated that:
	"The inevitable rise and spread of resistance will render existing drugs progressively less useful. In the absence of new drugs, this leaves us increasingly at the mercy of infections. We cannot eliminate resistance".
	Having done such a splendid job, the committee added that we could slow it down by using antibiotics only when necessary, and by rigorous infection control and basic hygiene, both enforced through surveillance. I hope that my noble friend Lady Andrews can tell us what the Department of Health has done about the committee's recommendation for a specific campaign against the inappropriate use of antibiotics, to be repeated at frequent and regular intervals. How effective is the Government's campaign on this and what are the intervals?
	Do we have sufficient basic knowledge to understand how bacteria mutate for their survival? Or is it the failure of the pharmaceutical companies to research and develop better antibiotics? What are the Government doing to press the pharmaceutical companies to conduct more effective research? It has been claimed that the companies are not doing sufficient research because it may not be profitable. Whatever the reason, it is vital that the Government take some responsibility for pressing them because new antibiotics are undoubtedly an extremely important factor in dealing with MRSA.
	It is difficult to pin things down, but a few weeks ago, in a Starred Question, I asked the Government to press the pharmaceutical companies to do further research on new antibiotics. The response was simply to say that it was important that we should invest in research in this area. That really was no answer. I should like to repeat the question to my noble friend tonight: will the Government press the pharmaceutical companies to intensify their search for new and more effective antibiotics?
	In so far as this is an international problem, the Government should consider calling a world conference of the countries with a particular interest to see whether we can get better co-ordinated research. How do United States pharmaceutical companies compare with ours for helpful research? The Government should campaign for closer co-ordination of research effort and facilities with countries like the United States and the European nations because this is a genuinely international problem.
	The battle with MRSA is undoubtedly one of the most important that the National Health Service has had to face since the heady and exuberant days of its foundation. We are all anxious that these so-called "superbugs" should be defeated, or the consequences will be catastrophic. I look forward to the response on behalf of the Government from my noble friend.

Lord Colwyn: My Lords, I thank the noble Lord, Lord Ashley of Stoke, for tabling this Question. I am grateful to him for the way in which he has explained the current situation. I should also apologise to the House because I decided only this morning to make a contribution to this debate and I called to add my name to the list at a very late stage. I am so used to being placed towards the end of a speaking list that I assumed that I would be in a similar position today. I was wrong, and I should say how much I look forward to the contributions from later speakers.
	I hope that I will be forgiven for suggesting some lateral thinking on the serious problem of MRSA infection at such an early stage in the debate. The title of the 14th annual Euro meeting in Basel this time last year was, "The patient is waiting". I interpreted that to mean that at the start of the 21st century, only a relatively small proportion of all diseases can be adequately treated or even cured, and only a small proportion of all patients have access to medicinal products at affordable prices.
	Although that may seem a harsh judgment, it is true that for some diseases we do not yet have a rational drug treatment; that diseases are often poorly treated, and that too many patients in poor countries do not receive any benefit.
	When I arrived at my surgery this morning, I noticed for the first time the actual wording of the Question tabled by the noble Lord, Lord Ashley, that might differentiate it from the recent series of Questions we have had on MRSA. He has asked whether there are any "new proposals". I suspect that there are no new proposals, so I thought that I would help the Government with a brief intervention in order to draw their attention to a therapeutic treatment that may well be able to control infection by methicillin resistant staphylococcus aureus. The treatment is not new in the sense that it has not been used before, but it will be new to the Department of Health, which must be prepared to examine a wider range of treatments rather than continue to rely on the search for a "magic bullet", the cure that the noble Lord, Lord Ashley, said he was seeking.
	I refer to ozone therapy. The gas mixture 02/03 is administered by various routes: topical application on skin and mucosa, or parenteral injection and exposure to blood. In any event, ozone will come into contact with a film of water present on the skin surface, or in the interstitial fluids, or in plasma.
	Basic clinical research on ozone therapy has been too little and too slow. I pay tribute to the noble Lord, Lord McNair—he was removed with most of the hereditary Peers—who tried to interest successive governments in this. But it takes time. The therapeutic progress in cancer therapy has not been as fast and positive as had been predicted. Three decades have already passed since President Nixon declared war on cancer. Although knowledge about tumorigenesis has shown an incredible expansion, the mortality rate has barely decreased.
	It is intuitive that ozone can have an important therapeutic role in various types of infections because it generates reactive oxygen species also produced by granulocytes and macrophages during an infection process.
	When faced by problems with diffuse antibiotic-resistant bacteria, rich countries continue to use often useless, expensive antibiotics, while poor countries, through sheer necessity, use ozone. It is used either as a gas, as ozonised bidistilled water or as ozonised saline or oils. These ozonised solutions have a cleansing effect and act as a powerful disinfectant that kills antibiotic- resistant and anaerobic bacteria.
	In these countries, physicians have had to devise all kinds of ways to employ the gas or, even more easily, the ozonised water, to avoid environmental contamination. In the West, we still need to create the mental attitude profitably to use ozone. Once medical personnel realise the advantages it will be put into general use to the benefit of patients. Moreover, with the current increase in medical costs, ozone therapy deserves attention because it reduces hospital assistance and is extremely cheap. The good news is that the work has been done and the equipment and knowledge are available.
	I apologise for introducing an aspect on which the Minister will not have received a brief. There is no doubt that ozone therapy will play an increasingly important role in healthcare in the future. Now is not the time to explain how controlled exposure to minute amounts of ozone can immediately halt the process of dental decay and eliminate the use of the dental drill. The prospects for primary dental care are enormous.
	I should also apologise to the noble Lord, Lord Ashley, for my deviation, but I sincerely believe that the Government should be prepared to assess a wider variety of treatments.

Baroness Masham of Ilton: My Lords, two months ago I sustained two fractures of my left leg when I got it stuck in a fire door in your Lordships' House. I went to St Thomas's Hospital for an X-ray and, as my bones are soft and the fractures were unstable, I needed an operation. A doctor at St Thomas's told me that in my case the risk of MRSA was very great and that it might be wise to go elsewhere.
	In 1997 I had the honour to be a Member of the Select Committee on Science and Technology relating to resistance to antibiotics and other antimicrobial agents. The committee reported on 17th March 1998. The report stated:
	"MRSA poses one of the biggest challenges to infection control. It is common, it moves easily between hospital and community settings".
	One of the recommendations in the report is that there should be a national MRSA strategy. This would control MRSA and also bear down on other infections. Even though Britain has had guidelines and surveillance, MRSA keeps increasing.
	I am grateful to the noble Lord, Lord Ashley of Stoke, for giving the House the opportunity to discuss this life and death matter today. Because of infections, many people have become most concerned about being admitted to hospital. In recent weeks I have heard of several people personally who have been infected with MRSA.
	On Tuesday, 25th March, I attended a service of thanksgiving for the life of Major General Sir James Eyre at the Guards' Chapel. He had been admitted to an Oxford hospital with complications. While there, he was infected with MRSA which his widow, a surgeon's daughter, says contributed to his death. She said to me, "Nothing about MRSA has been written on his death certificate". "Why not?", I asked.
	Last week, on Easter Monday, an old school friend came over with her husband. They told me that he had been admitted to St Mary's Paddington as an emergency in excruciating pain. He had an epidural but, before long, he developed a large sore with MRSA at the site of the injection. His wife was horrified at the lack of hygiene in the hospital and is writing to the chairlady, a Member of your Lordships' House.
	Later, while staying with a friend in France, he was again taken to hospital as an emergency. This time he was admitted to a clinic in Biarritz, which was spotless and the staff polite and clean.
	Recently, at a conference, I was talking to a supplier of paper towels. He told me that King's College Hospital had started using a good quality paper towel, which nurses liked and so they washed their hands. He said that the hospital had reverted back to hard, cheaper towels which made the nurses' hands sore, and so hand washing lapsed. I am sure that all noble Lords know the importance of washing hands between patients to help prevent the spread of hospital infections. Good quality soft towels are one source of encouragement.
	The public are getting frustrated at the dirty conditions of some of our hospitals, which have no discipline and supervision about cleanliness at the patient level. The Government have tried to do their best. More money has been given to the NHS, but it does not seem to have stemmed the spread of MRSA infection. Many people want to see the prevention of the spread by screening hospital admissions, detecting and isolating infected patients and, surely, screening hospital staff who may infect patients and become carriers. More special funding will be required for laboratories and infection control to implement these measures fully. The design of hospitals is important; they should have more basins and disinfection points, such as alcohol wipes and gels by every bed.
	We cannot go on increasing the risk to patients. Is it not time for a national research project on MRSA and other antibiotic-resistant organisms? I can think of no better place than Imperial College, in the heart of London, where MRSA has the highest rate of infection in this country. The worldwide problem of SARS has made people sit up and think of infection control.
	I would be grateful if the Minister could tell the House about reporting of staphylococcus aureus bacteraemias. Why is there a mandatory and a voluntary scheme? All regions reported higher numbers under the mandatory scheme. When looking at age distribution, this information is obtained only from the voluntary reporting scheme. It is worrying that babies under one have the highest rate of infection, followed by people over 65. Would it not be more efficient and less complicated to have one mandatory scheme?
	At a conference on the safety of surgical instruments some months ago, I asked a question on MRSA to a surgeon who was speaking. He said it was something which sometimes infected frail, elderly people. I detected some complacency. I said, what about the young man of 23 who went into hospital to have an ingrowing toenail removed and died of septicaemia, caused by MRSA, a short time afterwards?
	We have among us, in your Lordships' House, a living witness who is in the prime of life but nearly lost it from MRSA. The noble Lord, Lord Phillips of Sudbury, has given me permission to relate his experience in this important debate.
	The noble Lord returned from a visit to Africa and had to be treated in hospital for a tropical disease. When in Addenbrooke's Hospital in Cambridge, the noble Lord developed MRSA. Antibiotics were given through a cannula and drip, which is thought to be the cause of MRSA entering the bloodstream. The noble Lord was then found to be resistant to vancomycin. He had eight antibiotics and septicaemia in both sides of his body. The tropical disease was cured but the noble Lord was fighting for his life due to a hospital-acquired infection. I am pleased—I am very pleased—that the noble Lord won his case on that occasion, but it was touch and go.
	Antibiotic-resistant infections have become a huge challenge. For years, there have been hospital cover-ups, and priority has not been given to make hospitals safe places. Once when I was in hospital, I asked the young man cleaning my room if he had ever cleaned the dust from under the beds. He answered me, "Nobody ever asked me".

Baroness Pitkeathley: My Lords, I am most grateful to my noble friend Lord Ashley for giving us the opportunity to focus on this important issue tonight. It is rather ironic, as the noble Baroness, Lady Masham, has said, that so many people are getting so nervous about the relatively minor problem of SARS—do not mistake me, I am not in any way taking the deaths of people from that infection lightly—while ignoring the enemy within, as it were. As my noble friend has reminded us, MRSA is a killer, and a major one.
	In this debate, and especially in view of the number of experts who will speak to us, I want to share my experience as a patient. When I said I was grateful to be here tonight, I meant that most sincerely, since I, like the noble Lord, Lord Phillips, am a sufferer and, as you see, a recoverer from MRSA.
	In the seven months I spent in the Middlesex Hospital in 2001, I had MRSA for most of the time. I want to tell your Lordships about that experience and offer some ideas about the lessons I and others can learn from it.
	I am pretty sure that I can pinpoint the moment when I became infected. That is a moment for which I feel gratitude, not blame. I was suffering a complete body sepsis after surgery for cancer and a bad reaction to chemotherapy drugs. Admitted to the hospital as an emergency on Christmas Eve, the doctors despaired of my life and told my family to prepare for the worst. Then a wonderful and courageous surgeon told my family that he was prepared to operate. I say courageous, because many surgeons would be too aware of their mortality rate batting average to suggest such a course of action in an apparently hopeless case, even if it had not been Christmas Day. Although he could offer a less than 1 per cent chance of survival, without the surgery the outcome was certain death. So my family, knowing that I would always take the high-risk option, agreed.
	Another problem then presented itself, since I was so ill that even moving me to the operating theatre would surely kill me. They decided to operate in the room that I was occupying in intensive care. There was no time to ensure the sterility of the room, of course—they did the best they could in the short time available—but I think that I can be fairly sure that there was the source of my infection.
	That operation was not the end of the story, of course; much more surgery and many months of devoted care were to follow. However, your Lordships will not be entirely surprised to know that had I myself been conscious enough to make the decision, the risk of getting MRSA would have been one which I too would have been prepared to take in those circumstances.
	I tell that story to illustrate the complex nature of the decisions that NHS staff have to take, often with very little time to spare, often with lives at stake, often involving great risk, and often weighing one least worst option against another. I, too, join the calls for more vigilance against the spread of this dreadful infection, but we must always remember the practical circumstances of those who are responsible for patient care.
	I cannot fault the precautions that the staff in intensive care took to try to prevent the spread of infection. Such few visitors as were allowed to me were always told about washing their hands, wearing aprons and applying disinfectant gel. Of course, ward rounds do involve doctors and other staff moving from bed to bed, sudden emergencies arise and deliveries of supplies are absolutely essential. When one moves from intensive care to a ward, those precautions are even more problematic. Visitors have free access to most wards at most times of the day. There are not always handy basins for people to wash their hands; patients go endlessly to X-ray, to physio, to ultrasound, which all offer opportunities for infection to spread. But these visits are essential, of course.
	Your Lordships may be surprised to hear me say that MRSA was a great friend to me and my devoted family in some ways. It required me to be barrier nursed, which in turn required a side ward. That could be quite cosy, as I could have my radio and TV, my visitors and my endless undignified examinations in some privacy. But there were only two side rooms on the whole of the ward, so what happens if more than two patients need barrier nursing? There were times when I had to be on the open ward and the beds there were pretty close together. But when you are immediately post-operative, the nurses need to keep you under close surveillance, and the side ward with its closed door is not then the safest place, in spite of the risk of infection.
	If a crash call comes when a nurse or doctor is attending a patient, and they know that their colleague is alone at the other end of the ward, washing their hands and changing their apron may not be the first thing on their minds. If there is only one night sister or house doctor on call for a large group of wards at three in the morning and a new line or ventilator is urgently needed, it is perhaps understandable that hygiene takes second place.
	If a patient is unable to eat for months on end, as I was, the only means of keeping them alive is via a Hickman line putting food into the blood stream. By their very nature, such lines become infected after a few weeks. However, one then has to balance the risks of sending the patient back into the theatre for more surgery, because a new line has to be put in under general anaesthetic, against the risk of the spread of the infection.
	I do not offer these examples of difficult decision making as excuses, but simply to ensure that we never lose sight of the difficulties faced by the staff to whom I and many others owe their lives.
	The best way of avoiding MRSA is undoubtedly not to go into hospital at all or, if one must go, to stay as short a time as possible. In that regard, the Government's policies are to be validated: increased co-operation between health and social services, shortening the time it takes to arrange care in the community, which we hope will be the result of the Community Care (Delayed Discharges) Bill. That is especially important for older people who have orthopaedic surgery. In their post-operative period they are especially prone to infection, and it is notoriously difficult to overcome. Moreover, most people want to return home as soon as possible.
	New technology systems exist that enable health and social care staff to use their time in the most effective, patient-centred way. As well as in-home systems, we are now able to give on-call GPs access to minimum data on patients to allow them to assess patients seen as an emergency in their own home, instead of admitting them to an A&E department. Therefore, we can provide monitoring at home, thus avoiding the risk of hospitalisation.
	Another very important element in the fight against hospital-based infections to which the Government are committed is the development of small diagnostic and treatment centres—DTCs. These are already established in some parts of the country, and I have seen them operating effectively in the United States. They specialise in cold surgery and patients are in and out in a day. I am sure that the development of these centres to enable patients to have surgery without the risk of infection will be an important factor in fighting MRSA.
	As one district nurse said to me, one thing that we can say about MRSA is that people never get it in the community. She was right. Hospitals are the culprits, as we have heard tonight. So we must proceed on two important fronts. We must improve hygiene in hospitals and continue to fund appropriate research. But we must keep people out of hospital as much as possible by looking at other forms of care which will not only preserve them from infection but also offer them treatment and care that fits their lifestyle, instead of expecting them to fit in with hospitals' routines and culture.
	I am extremely grateful to be recovered in health and that I did not die of MRSA or any of the many other things which might have killed me. My devotion to the NHS, which was already strong, is, as your Lordships can imagine, unshakeable now. So I hope that we can all approach the undoubtedly challenging task of tackling MRSA. I hope that we can do so in a way that offers help, not blame, to the NHS and its skilled and devoted staff.

Lord Chan: My Lords, I add my congratulations to the noble Lord, Lord Ashley, on drawing the attention of your Lordships' House and the Government to this troublesome infection which has recently become more common in our hospitals, is more difficult to treat and undoubtedly contributes to an increasing number of deaths. I also thank the noble Baronesses, Lady Pitkeathley and Lady Masham, for sharing their personal experience and adding realism to the debate.
	Methicillin resistant staphylococcus aureus is a problematic infection acquired in hospital. According to the Public Health Laboratory Service, which monitors the extent of such infections in Britain's hospitals, and as the noble Lord, Lord Ashley, said, MRSA infections in England and Wales increased by 50 per cent, from about 4,800 cases in 2001, to more than 7,000 last year. Vancomycin is the drug of last resort for treating patients, particularly in hospital, with postoperative infection. As the noble Baroness, Lady Masham, described in relation to the noble Lord, Lord Phillips of Sudbury, some cases of MRSA are showing signs of developing resistance to Vancomycin. Britain's first case of VRSA—Vancomycin resistant staphylococcus aureus—was reported only last year. That was the first fully Vancomycin resistant strain of bacteria. As a result, doctors are faced with a very difficult-to-treat bacterial infection that can cause death.
	Hospital-acquired infections have been greatly underestimated and they are increasing every year. Bacteriologists such as Professor Hugh Pennington estimate that hospital-acquired infections kill around 5,500 patients annually and contribute to the deaths of another 11,000. Some members of the public have proposed that the spread of MRSA may be the result of dirty hospitals with poor levels of cleanliness. The Government have rightly set up their Clean Hospital Programme to tackle the problem. However, a new study found that all 40 hospitals with the worst MRSA infection rates passed cleanliness tests. Two thirds of hospitals with the worst record for controlling MRSA infection had won a "green light" rating for cleanliness, while the remaining third were classified as adequate with an "amber" light.
	The noble Lord, Lord Ashley, mentioned the study by Paul Burstow, the Liberal Democrat health spokesman, who looked at 20 specialist and 20 acute hospitals with the highest rates of infection. He said that the Clean Hospital Programme covers 19 different standards of which only one is about cleanliness and none about the control of infection. Mr Burstow said that it proved that not enough was being done to tackle the problem of rising MRSA infections in hospital.
	Stringent measures to isolate patients with MRSA infections would control its spread in hospital wards. However, common measures such as hospital doctors and nurses washing their hands scrupulously before and after handling postoperative patients should be implemented. We have heard about the problems that can arise when patients are very ill and that is not done. Epidemiological evidence concludes that bacteria transmitted by the hands of people who care for inpatients are a major contributing factor to hospital infections. Effective hand decontamination results in significant reductions in the carriage of potential bacteria on the hands and would lead to a reduction in infected patients and death from MRSA infections. I can testify to the importance of this simple measure from my professional experience as a paediatrician caring for new-born infants.
	Soap and water are as effective as hand-washing preparations containing antimicrobial agents for decontaminating hands. In order to reduce chaffing of the skin through soap and water, alcohol-based hand rub can be used with good effect. Good quality hand-washing by hospital medical staff needs therefore to be monitored to prevent and control infections, particularly in the care of patients such as babies and very ill people who have catheters fitted.
	Another issue of importance in the campaign against MRSA infections is that of the careful use of antibiotics particularly in primary care. The Department of Health has printed and distributed information for patients on the appropriate use of antibiotics. It should be available in GP clinic waiting rooms. I have a copy in my hand.
	Antibiotics may be unnecessarily demanded by patients for common coughs and colds usually caused by viruses for which they have no therapeutic effect. As large numbers of prescriptions for antibiotics are dispensed in primary care, more should be done to inform patients, nurses and doctors that antibiotics are not effective for treating common viral infections.
	General practitioners should be encouraged to take care when prescribing antibiotics for their patients. In some primary care trusts, including the one with which I am involved, this is achieved through seminars where pharmacists inform doctors of trends in prescribing and evidence of good practice.
	Patients who have been prescribed antibiotics appropriately should be encouraged to complete their course and not stop when they feel better. A full course of treatment will help prevent bacteria from developing resistance to common antibiotics.
	Best practice in treating bacterial infections both in the community and in hospitals is well known. Standard principles for preventing hospital-acquired infections were updated and distributed by the Department of Health and published in The Journal of Hospital Infection two years ago in a supplement. It is easy to read and is available on the Internet.
	These measures needed to prevent infections acquired in hospital are also not rocket science. But effective control and treatment of infections and preventing their spread requires all hospital staff to keep to a routine of hand-washing and patients to co-operate by completing their courses of treatment with prescribed antibiotics. Prevention is better than cure. This adage is absolutely essential for MRSA infections. I look forward to the Minister's reply on these important issues to reduce MRSA infections in hospitals.

Lord Rea: My Lords, as he so often does, my noble friend Lord Ashley has put his finger on an important unsolved problem facing the National Health Service.
	As other noble Lords have said, MRSA is not the only healthcare acquired infection but it is the most intractable and is often severe, causing up to an estimated 5,000 deaths and, where it was just a contributory factor, 15,000 deaths. Those are slightly different figures from those given by the noble Lord, Lord Chan, but they are near enough to show that that is probably the rate. What is more, as all noble Lords who have spoken have said, it is increasing rapidly. From 1992 to 2001, the proportion of methicillin resistant staphylococcus among all staph aureus infections cultured by the PHLS rose from 2 per cent to 42 per cent. The reasons for that are not difficult to find. Antibiotic resistance increases where antibiotics are frequently and often inappropriately prescribed. So hospitals where the most severely ill are treated provide an ideal environment.
	Like the noble Baroness, Lady Masham, I was a member of your Lordships' Select Committee in 1998 which reported on resistance to antibiotics. In fact, the noble Baroness prompted that inquiry because of her repeated parliamentary Questions on the topic. It is gratifying that several of the recommendations of that report five years ago have been acted on. However, in its follow-up report three years later, the committee stated in paragraph 24 on page 7, with regard to the requirements that hospitals should report MRSA incidents:
	"We are surprised that this has taken three years; the bacterium has not been idle during this time. We are nonetheless pleased that it is now to go ahead".
	As the Minister observed when we interviewed her,
	"publishing these figures will concentrate the minds of Chief Executives of hospital trusts".
	Although the Department of Health is only too acutely aware of the problems of increasing resistance of micro-organisms to antibiotics, especially MRSA, the changes needed to slow the increase or reverse it need to be taken, as other noble Lords have pointed out, at front-line level, through changes in behaviour or management, mainly by clinical or cleaning staff. Strategies, guidelines and circulars by the department, however well written, are only bureaucratic instruments. Although they are a necessary precursor to changes in action at ground level, they are no substitute for that action, which is what matters.
	I am sure that my noble friend will give us an account of the many excellent initiatives taken by the department, but we need to know how far they have led to action on the ground. To find that out, we need adequate and accurate monitoring or, on occasions, specially commissioned research. For instance, I understand that a team from Thames Valley University has carried out a systematic review of how infection control guidelines are implemented. Can my noble friend give us any information or a progress report on that?
	As the Select Committee showed in its 1998 report, an attitude among prescribing doctors prior to the 1980s led to antibiotics being over-freely prescribed. Doctors believed—I think that I can remember it myself—that if resistance to one antibiotic developed, another would be discovered. The Select Committee's report had a salutary effect, as did the department's monograph, The path of least resistance. For the past few years, there has been a fall in the prescribing of antibiotics by 9 per cent among GPs, and a more cautious policy in many hospitals.
	A further factor, as almost all noble Lords who have spoken have said, has been a fall in standards of ward hygiene. That is not always due to careless attitudes among nurses and doctors or poor work by cleaners. Hand washing between treating patients is often difficult to fit in if the sink is at the other end of the ward and there is extreme pressure of work, which is of course too often the case in acute hospitals. Rapid turnover of patients and more than 100 per cent bed occupancy makes it difficult to clean beds and equipment thoroughly. We have had examples of that from my noble friend Lady Pitkeathley. Those faulty practices are not desirable or excusable, but the present hospital environment, pressure of work and occasional low morale among those under pressure does not help.
	It is in that kind of setting that the work of infection control teams is not easy, although vital. The liaison nurses who are supposed to see that good practice prevails in their ward or department may not have the time, or the status among their colleagues—that is quite important—to be effective. However, even in those circumstances, infection control nurses still play a vital role. Chief executives of trusts increasingly realise that the work of those teams is cost-effective in reducing the average length of hospital admissions.
	The results of the first year's surveillance of MRSA bacteraemia for 2001, which was mentioned by other noble Lords, were published last year. The highest levels were in acute teaching hospitals in Birmingham and the South East. That is probably because their case mix contained a high proportion of often elderly patients with complex problems. I do not of course include my noble friend in that category; she had the complex problems but she is not elderly. Some people may have been referred from nursing homes or residential homes and brought their infections with them. I believe that some residential homes act as reservoirs. That is certainly the case in the United States. My noble friend Lady Masham may be pleased that in the bacteraemia surveillance study Stoke Mandeville had one of the lowest rates in the country.
	Despite the Question of my noble friend Lord Ashley, I shall be surprised if the Minister will describe any completely new approaches for MRSA control. Many plans are in train—for instance, to improve the scope of surveillance, to include general practice and the community, to increase the number of infection-control nurses, to increase the number of the excellent "modern matrons" and to ensure that hospital hygiene is improved. There are specific policies for chasing that up.
	I wonder whether the Minister can really show us that we are turning the problem around. Research to develop new antibiotics, as other noble Lords have mentioned, is needed. That anticipates the day—I am afraid that we have already reached that day—when MRSA becomes VMRSA. But even if a new antibiotic were found to replace Vancomycin, that would probably lead only to a temporary respite.
	We need basic high-quality infection control, as in the days before antibiotics were available, and careful, "prudent" prescribing. Those two approaches will probably remain the best ways of tackling the problem for the foreseeable future.

Baroness Finlay of Llandaff: My Lords, like other noble Lords, I thank the noble Lord, Lord Ashley of Stoke, for introducing this important debate. I must declare an interest because I am a member of the science and technology sub-committee that is currently examining ways of fighting infections. My remarks do not in any way pre-empt the report. I am concerned that by focusing only on MRSA we may be missing the main point. We should concentrate on all healthcare-acquired infections and, within that, hospital-acquired infections across the board.
	The noble Lords, Lord Chan and Lord Rea, outlined the problem but it is unclear whether MRSA is a reliable surrogate marker for healthcare-acquired infections. It may be a distractor from some other sources of infections. We need to know whether an organism is a patient commensal or acquired when it causes a septicaemia. We do not have robust epidemiological data from the community as a whole or from across hospital staff. As the noble Baroness, Lady Masham, requested, research in epidemiological surveys is needed; we also need to determine the amount of antibiotic resistance. There is great concern that antibiotic resistance may and probably will increase. Containing antibiotic prescribing may become more difficult as prescribing is extended to groups other than doctors in the healthcare team.
	As the noble Lord, Lord Chan, said, education is required—it is done for general practitioners—but perhaps education of the public at large is needed. A recent copy of The Big Issue, produced by the homeless, contained an excellent article on the dangers of overusing antibiotics. I believe that the publishers should be commended because they were reaching a group of the population who need that information.
	We need to collect robust data on infections and clinical outcomes and not only on the instances of infections. We need to know how many infections lead to death. Laboratory data are not enough. But the importance of laboratories must not be underestimated. We know that there are difficulties in recruiting and retaining laboratory staff as medical scientific officers, yet they are the backbone of the surveillance that will inform clinicians.
	Vancomycin resistant staphylococcus aureus may be much more dangerous and is emerging horribly rapidly. If a person has methicillin resistant staphylococcus aureus, it may be possible to treat him with vancomycin, but if he is vancomycin resistant, he really is in very deep water.
	Setting crude targets, which unfortunately have caught the public's eye, may be self-defeating. If a hospital is coping badly with infections, it is relatively easy for there to be a 10 per cent improvement. But if that hospital is already doing well, it may be quite difficult to achieve a 10 per cent improvement. If one takes care with blood cultures and they are produced as frequently as they should be, then there may be a very high pick-up rate, whereas if they are not dealt with as carefully as they should be there may be a distortedly low pick-up rate.
	The problem with figures is that they need careful interpretation. Perhaps I may give your Lordships a quick example. I was fortunate enough to have the data for 2002 on the 18 hospitals in Wales. One hospital had the sixth-from-lowest rate per 1,000 bed days for methicillin sensitive staphylococcus aureus—the ordinary staphylococcus aureus—in blood cultures. Therefore, it is doing well. But that same hospital comes 12th out of the 18 for MRSA bacteraemia per 1,000 bed days. That is different from some of the other hospitals around. Therefore, one needs to ask what is going on and why, and that is quite complex. Many factors need to be considered: indwelling lines have been alluded to. They are generally associated with sicker patients. Of course, the risk of any bacteraemia is higher in a patient who is immuno-compromised.
	There is a great need for good buildings—isolation rooms, adequate space between beds and enough sinks. One sink per bed is the dream of most healthcare workers. Most people are working in places where it is extremely hard to provide care and to carry out their jobs as well as they would like to do. My own ward has lamentably overcrowded bed areas with inadequate sinks. But the major refurbishment, which is badly needed and long overdue, has been competing with the installation of an MRI scanner, the chemotherapy pharmacy bill, covering for staff sickness and locum payments, and so on. We were recently turned down for an NOF bid, and that has left the staff profoundly demoralised. I fear that our infection rates will climb as a result because it is very hard to maintain good infection control at all times, as has already been alluded to.
	Since April 2001, a mandatory scheme in Wales has recorded the occurrence of bacteraemias due to all staphylococcus aureus. A recent important Department of Health initiative across the UK, involving all four countries, required mandatory reporting. That has focused on orthopaedic cases, but it now needs to be broadened and rolled out across all areas of healthcare and to cover all healthcare-acquired infections.
	We must be able to identify through research the critical areas where interventions have a clinical impact and where matters are improved through the interventions taken. As the noble Baroness, Lady Pitkeathley, said, these are complex issues and no one measure will be the magic bullet. For example, each surgeon needs to know the data on his or her patients for all hospital-acquired infections. However, providing all that data requires resources.
	Hygiene and visible cleanliness must not be confused. It is possible that when cleaning is done in haste in an effort to meet targets, organisms are spread around rather than being left undisturbed to die in a pile of dust or sweet wrappers on the floor, which would give the visible appearance of a place being dirty. One needs to have time and resources to do even the cleaning required to ensure that one does not inadvertently spread organisms because they are not visible to the naked eye.
	In understanding infection, comparative areas need to share data, identify the reason for their rates and look at the details of their clinical practice, such as the dressings which are used, the way they are put on and so forth. We may need to go away from the current pharmaceutical industry and not put our hope in new antibiotics. All organisms will mutate rapidly and develop resistance.
	The noble Lord, Lord Colwyn, spoke on this theme at the start of the debate. It may be that old remedies for contained superficial infections, such as venous ulcers, should be used. The use of things such as iodine, honey, yoghurt, icing sugar or maggots to debride necrotic wounds may in the long term be a safer way to go, but long-term research and surveillance is needed. Academic microbiology departments must be encouraged and increased. It is only through high-quality research that the answers will be found. Crude targets have a habit of rebounding badly and consuming resources to appease headline writers rather than improving patient outcomes, and it is on patient outcomes that we need to collect data.

Viscount Bridgeman: My Lords, I am grateful to the noble Lord, Lord Ashley, for initiating the debate. I am also grateful to your Lordships for permitting me to speak during the gap. I declare an interest as chairman of the independent Hospital of St John and St Elizabeth in North London.
	I spoke today to Dr Bill Chattopadhyay, who is a consultant microbiologist at the North Middlesex Hospital. He is also a consultant at the Hospital of St John and St Elizabeth and an inspector of the Clinical Pathological Accreditation (CPA). He is acknowledged as one of the foremost experts on MRSA in this country. He suggested I made two very simple points, which I address to the Minister for her consideration and, I hope, implementation.
	The first is the washing of hands continually and between dealing with patients. Those points were made by the noble Lord, Lord Ashley, the noble Baronesses, Lady Masham and Lady Pitkeathley, and predictably and at some length by such a distinguished practitioner as the noble Lord, Lord Chan. However, the point Dr Chattaphady wants to make is that in his view there is a lamentably low priority given to this simple subject in the training of junior doctors and health professionals. I hope that that can be implemented in future programmes.
	The second point he wants to make concerns the acute shortage of side rooms in hospitals, which are important for the isolation of MRSA. I hope that the department, in its future planning of new hospitals and the refurbishment of existing ones, will give high priority to the provision of side rooms. I look forward to the Minister's reply.

Lord Clement-Jones: My Lords, I, too, thank the noble Lord, Lord Ashley, for initiating the debate, for the way he introduced it in such a commanding and comprehensive way which allows us to debate the subject, and for eliciting the speeches that have been made by other noble Lords, which have been a very rich mixture of personal experience and professional expertise.
	The view shared by all noble Lords is that it has been clear for some time that hospital-acquired infection in this country is not under proper control. Indeed, now it appears to be spreading beyond the hospital environment. There are clearly major consequences involved in hospital-acquired infection. Patients who have or get HAI stay in hospital on average about three times longer than non-HAI patients. That is equivalent to an extra 14 days per HAI patient. So this is a major cause of delayed discharge. We have heard some pretty harrowing stories from all Benches in this House. The statistics are that an HAI patient is seven times more likely to die in hospital than an uninfected patient. That is a pretty horrifying statistic.
	In February 2000, the National Audit Office published a highly critical report on the control of infection in acute hospitals in England. The NAO found that healthcare-acquired infections caused more than 5,000 deaths per year and cost the NHS £1 billion. It subsequently appeared that—and many noble Lords have alluded to this—the rates of MRSA in 2001 were nearly 50 times higher than they were in 1992.
	Several noble Lords have talked about the voluntary reporting statistics. Of course we now have the mandatory statistics which are in many ways even more horrifying. The mandatory figure for the six-month period at the beginning of 2002 stands at 3,515 for MRSA cases. If that trend continues throughout the whole year there will be 7,000 cases of MRSA.
	In response to that critical NAO report, the Government responded by initiating what they called a "clean-up drive" for hospitals in the autumn of 2000. That campaign—and this is what I want to dwell upon tonight—was comprehensively taken to task by my honourable friend Paul Burstow MP in his report Now wash your hands, which was published in September last year. My honourable friend's concern about this matter arises directly as a result of his spokesmanship and concern for the health and welfare of older people, who are particularly affected by HAI.
	The campaign was allocated a sum of £60 million to finance the clean-up of NHS hospitals. Patient Environment Action Teams (PEAT) were formed to inspect wards. These bodies comprised volunteers from within the NHS and some patient groups. Their responsibility was to grade the trust as "red" for poor, "yellow" for acceptable or "green" for excellent.
	In order to do that, the teams looked at 19 categories. The noble Lord, Lord Chan, alluded to that. But only one category pertained to hygiene or cleanliness and none was about the control of infection. The other standards were made up of such arbitrary subjects as the appearance of linen and décor, the tidy state of public areas, even CCTV in car parks and easy-to-read signage. A hospital that scored one on cleanliness but scored highly in other areas could therefore be rated highly. It is therefore possible for a hospital to be designated "green", or excellent, because it is well decorated and there are clear signposts, even if it receives a low score on cleanliness.
	It is obviously appropriate that hospitals should provide a good, safe environment for patients, but for that to be characterised as conforming to standards of "cleanliness" is misleading. It means that the traffic light system seems to have been more about public relations than infection control.
	In autumn 2000, all NHS trusts were inspected by PEAT. The results of the inspections were not published but were leaked to The Times in January 2001. The inspections were repeated in the spring and the autumn of 2001, with only 42 "red" hospitals in the spring and none in the autumn. When they were published in October last year, the Secretary of State claimed:
	"The cleaning campaign in England's hospitals is working. In April I announced national standards for hospital cleaning and that by autumn no hospital would have poor standards of cleanliness. We have got there".
	The picture painted by my honourable friend's survey carried out within NHS hospitals at the end of last year, which was sent out to all NHS hospitals, is very different. The survey revealed a shocking lack of resources for infection control teams; 61 per cent of respondents felt that they did not have adequate resources to carry out their role effectively; and many highlighted the need for more administrative support in order to provide valid information on infection rates. There were alarmingly low ratios of infection-control staff to beds. There were equally alarming responses on key areas such as handwashing and cleanliness of staff uniforms.
	As mentioned by the noble Lord, Lord Ashley, to cap it all, new research from my honourable friend shows that out of the 40 hospitals with the most MRSA cases, not one was classified as a "dirty" hospital under the Government's "Clean Hospital Programme" which Ministers championed as tackling the crisis. The analysis undertaken by my honourable friend looked at the 20 specialist and 20 acute hospitals with the highest rates of infection of MRSA. He found that 28 hospitals were classified as "green" and 12 as "amber", despite having the highest rates of infection in England.
	Clearly, the situation cannot continue in this way. Ministers must stop giving the impression that they are on top of this problem and acknowledge that the "Clean Hospital Programme" is nothing of the kind. It is giving patients and families a false sense of security when the Government are not on top of the MRSA problem.
	What needs to be done? Infection control must be placed even higher on the Government's agenda. There must be a sustained effort to maintain cleanliness standards, not just a one-off, gimmicky clean-up drive. Infection control teams must be given the resources and authority to undertake their jobs effectively. During our debate on SARS on Monday, the noble Baroness replied to me by saying that of course resources must be provided for infection control teams, but the fact is that there must be an audit, whether by CHI or the SHAs, to ensure that money is getting through and that the teams are properly resourced.
	There should be independent inspection of hospital cleanliness and infection control—perhaps by the Commission for Healthcare Audit and Inspection—which would give an objective, national picture of the cleanliness of England's hospitals, so that patients can be sure that everything necessary is being done. As several noble Lords have mentioned, there should also be an intensive drive to look for alternatives to antibiotics. I remember five years ago, when we debated the Select Committee's report in 1998, raising the question of progress on bacteriophages. The National Endowment for Science, Technology and the Arts has funded research with £50,000. What research have the Government or the Medical Research Council funded to any significant extent in that area, which seems such a promising line to pursue?
	The vigourous tackling of HAI, and MRSA in particular, would do wonders to increase capacity and lower mortality in the health service. Not enough is being done and I look forward to hearing the Minister's reply.

Earl Howe: My Lords, the House will be indebted to the noble Lord, Lord Ashley, for giving us an opportunity to debate an issue that has very serious implications for patients in the National Health Service. The noble Lord brought the facts home to us most powerfully.
	Hospital-acquired infections are no joke. For the individual, their effects vary from mild discomfort to prolonged disability and, in some very serious cases, death. The statistics for such matters are always difficult to collate but, in 2000, the National Audit Office estimated that at any one time about 9 per cent of in-patients had a hospital-acquired infection, which equates to at least 100,000 infections a year.
	Apart from the cost to human health, there is of course a significant attendant cost to the NHS itself, a good proportion of which—perhaps a third, according to the PHLS—could probably be avoided by better hospital procedures. Because of that, there is an opportunity cost in terms of beds that could otherwise be occupied by patients waiting for hospital treatment.
	Those rather depressing facts form the general backdrop to this debate. If we consider hospital-acquired infections as a whole, MRSA accounts for about a quarter of them. It causes wound and bloodstream infections, which can be particularly serious. Those who are debilitated, sick or who have weakened immune systems are susceptible to it. Anyone who has an open wound, such as a bedsore, or a tube going into their body, is potentially prey to it.
	It is not for people such as us, mere parliamentarians—of course, I exempt the medical parliamentarians—to try to tell NHS managers and the medical professions how to do their job. I venture to say that it is not for Ministers to do that either. We know what the NAO has said about how MRSA is transmitted and how such transmission might be better prevented. We can note that with considerable interest. We can welcome the fact that there are infection control guidelines and that CHI will monitor how they are implemented.
	The job for the Government is perhaps threefold. It is, surely, to facilitate the compilation of reliable data to enable everyone to be clear about the nature and scale of the problem; to ensure that systems are in place that hold the NHS to account; and to facilitate and encourage research that may one day lead to an elimination of the infection.
	On statistics, the Government have made a useful start by making it mandatory for all hospitals to report MRSA infections. The first comprehensive set of annual figures was published last October. What was interesting—and alarming—about those figures was the large increase in the rate and number of infections compared with the old voluntary reporting methods. The statistics also revealed considerable regional variations in prevalence, with London, for example, registering three times the rate seen in the West Midlands. It is clear that, taken as a whole, the UK's record compares unfavourably with that of every other country in the EU apart, I believe, from Greece. That is not a cause for pride, but it is at least a help that we are beginning to get a feel for how extensive the problem is. We have a benchmark.
	As we heard, blood infection rates from MRSA vary considerably between hospitals. The rates tend to be higher in the South East and lower in the North. A relatively high rate seen in one hospital is not necessarily a reflection of that hospital's clinical procedures. We must always bear in mind the case mix, the levels of risk typically seen in the hospital's patients and the number of patients transferred from other hospitals or care homes when already infected with MRSA.
	It is therefore difficult to compare one hospital with another on a crude basis, but we ought to be able to monitor trends. It is too early to know what progress has been made since March 2002, which marked the end of the first year's mandatory reporting. The noble Lord, Lord Hunt, last month quoted figures that possibly indicated a levelling out of infection rates in the nine months to last September. Since then, press reports have shown a substantial leap in the rates between 2001 and 2002. The PHLS apparently detected a rising trend; the Department of Health, on the other hand, was more cautious in its interpretation.
	Whatever trends emerge, it is obviously important that the figures submitted by acute trusts, as in any other area of data-gathering, are subject to audit. It would be helpful if the Minister could tell me how that is being done.
	There are still a few antibiotics that can successfully cure MRSA in its more common manifestations. However, as reports come in of bacteria that are resistant even to the last resort antibiotic—Vancomycin—we do not need doctors to tell us that we are living on the edge of a very dangerous precipice. In California, a new strain of MRSA is being spread with alarming ease among healthy people outside hospitals. Although the bug is currently treatable, the fear is that it will soon acquire resistance. It is welcome that much is being done to disseminate good clinical practice by means of workshops in acute trusts and the publication of manuals. I am also conscious that NICE guidelines for infection control and prevention are due for publication very soon if they have not already been published. It would be helpful to hear about those from the Minister.
	More research is needed. MRSA is a scourge affecting just about every country in the world. Can the Minister give any indication of what research programmes are being conducted in the UK, or abroad, in this field? I read recently of some promising work being done at Strathclyde University. It involves introducing water-borne viruses into dressings and stitches. Those benign viruses have been created to target and kill the three most common strains of MRSA found in UK hospitals. I understand that the initial trials are due to take place on animals and that if those are successful, studies on patients could be conducted within three years or so. The particular technique has been patented by the university and may have many other applications in combating infectious diseases.
	Research is long term and its results uncertain. Nevertheless, I am sure that it is essential for there to be no defeatism about MRSA. A report by Eurosurveillance, a body funded by the European Commission, stated unequivocally that,
	"it is possible to suppress and prevent MRSA from becoming endemic in hospitals".
	It then cites the rigorous isolation procedures in force in Dutch hospitals, which have notched up an impressive record in preventing the spread of MRSA once detected. It is good to see such an authoritative body being so categorical and positive.
	But positive thinking should never be obscured by false expectations. The public should not be led to believe—as I fear that they have been—that salvation lies in improving standards of hospital cleanliness. As the noble Lord, Lord Clement-Jones, said, it is striking that 13 of the top 20 worst offending trusts for MRSA received the highest cleanliness rating. Hospital cleanliness is vital, but there is no direct correlation between the general standards of cleanliness on wards and the prevalence of MRSA, and Ministers should not allow anyone to believe that there is.
	The direction of travel that the Government have charted for the NHS will enable difficult problems such as MRSA to be tackled even more effectively. I refer to the drive towards greater local accountability, the devolution of budgets and, in particular, the foundation trusts. Best practice must be disseminated, but it will make its presence felt most effectively if hospital doctors, nurses and managers claim ownership of it and can see its direct relevance for them, for their hospital and for their patients.

Baroness Andrews: My Lords, I am grateful to my noble friend Lord Ashley of Stoke for creating, in his usual far-sighted and committed way, another opportunity for us to address one of the most serious problems facing hospitals. As I expected, we have had an expert debate. There has been lateral thinking, as well as expert thinking, and I am grateful to your Lordships who brought to the debate not only expertise and great knowledge but telling personal experience of being in hospital. The desire to make abstract generalisations falls away when one hears about people's actual experiences in hospital. I am grateful that noble Lords were able to share that with us, and I am delighted that they are with us to do so.
	I shall scrap the first few pages of my speech, as the issues have been covered so admirably in so many different ways. I start by saying that, as my noble friend Lady Pitkeathley said, we have robust strategies to reduce infection rates, but we must acknowledge that the best practice cannot prevent everything. My noble friend said that she could not fault the staff, but our knowledge suggests that we can prevent only about 30 per cent of hospital-acquired infections. We must examine the issue, and I take the point that the noble Baroness, Lady Finlay of Llandaff, made. She said that we must not forget that the context is all hospital-acquired infections. That is important.
	In the short time that I have, I want to focus on action and implementation. I hope that I can reassure noble Lords that this is a priority for action and not simply for the promotion and production of guidelines and advice. I want to deal with that.
	My noble friend Lord Ashley of Stoke and the noble Earl, Lord Howe, referred to the potential for new strains to emerge. We must acknowledge that MRSA infections are a particular problem not only because they are difficult to treat but because they spread, not least because we have been so clever in inventing new technologies and new treatments and delivering them through the National Health Service in the past 20 years. In a way, our success in developing invasive devices has created new and easy routes of entry for infection. There are new strains. I think the noble Earl referred to recent community outbreaks in the United States caused by the Panton Valentine leukocidin or PVL-producing strain. It is extremely nasty and produces painful boils and skin abscesses. The Health Protection Agency recently summarised the data available on that strain and is investigating the occurrence. So far, there is no evidence to show that we should be concerned here. We have no particular cause for concern.
	I shall briefly consider the issue of data. This is the first year of our mandatory reporting system. It is important that we are clear that it has been introduced, because of the unreliability of the voluntary data collecting system that we have had to date. Noble Lords quoted differing figures of 4,000 and 7,000 cases. The figures produced in the first year of the mandatory system showed 7,227 reports of MRSA. I think that the 4,000 figure was for the same year but was based on the voluntary collection system.
	Therefore, it is important to be clear. As the noble Lord said, that illustrates that one of the chief tasks of government is to collect proper data. The media do not appreciate this. The reference made to recent reports in the media, which suggested that there had been a great hike in the number of cases, was the result of monthly figures being cited as weekly figures. So we must be extremely careful in what we read and how we interpret information.
	We cannot fail to acknowledge that our rates of MRSA are high compared with northern Europe. It may be that this is, in part, because of our ability to treat more vulnerable people, such as the elderly, with new techniques. It may be because isolation is not easy. I think that noble Lords who raised the need for isolation would agree that it depends entirely on the circumstances and facilities of the hospital. Certainly, in our new-build hospitals, built under consumer guidance, there is more space and provision for hand-washing. I am sure that we shall see the evidence of that as the service is provided.
	Of course, we recognise the pressure of life on the wards. My noble friends Lord Rea and Lady Pitkeathley gave some very telling examples of what that means. It is not an excuse to say that hygiene can be short-circuited, but it is an illustration of the pressure. Some of these issues are being addressed, such as smaller wards, more space around beds and improved procedures. But we must ensure that the guidelines issued in January 2001 are implemented, that infection control and basic hygiene, at the heart of good management, are in place and that the vanguard infection control teams are there.
	The implementation workshops are a very serious attempt to ensure that people who need to be refreshed and refocused on this work get the chance to be retrained and obtain additional advice. The workshops are just starting and will involve front-line hospital staff.
	I turn now to the impact that reports—not least the Health Select Committee report on which the noble Lord played such a key role and the NAO report—had on our strategy. As a result we introduced our first national strategy for getting ahead of infection, entitled, Getting Ahead of the Curve. That is now being translated into local targeted action plans which we are expecting to be ready in the next few months. They will set out different levels of operation nationally and locally—as well as internationally—on how we build on current work that is under way. Therefore, we have the national strategy and we have more robust data. It is mandatory surveillance and is about getting the right information to the right people.
	It is important to understand that that is the first step. It will provide the means to monitor and tackle hospital acquired infections as a whole. As it develops, we shall be able to look at a whole range of issues. The National Institute for Clinical Excellence guidelines are expected to be published in the summer. We are confident that they will make a difference to the way in which people in the community, in care homes and in intermediate care are able to draw on the experience of hospital infection work in the acute sector and that there will be a much more effective transfer of information.
	How do we ensure that this reaches the heart of the problem? Many noble Lords asked how we know that our policies are working. We already require chief executives, through the controls assurance standard, to ensure that effective policies are in place and are implemented. However, we recognised that more needed to be done. We recognised that chief executives had to be focused. That is why healthcare-associated infection is in the NHS performance management system. That has been done. Those procedures, MRSA improvement score and infection control are now performance indicators. They will contribute to the star ratings and will ensure that attention is focused on infection control. That must be the most effective thing we can do.
	We are seeking to build partnerships by working with the professions to roll out practical solutions. I cannot go through all the activities because they form rather a long list, but I shall mention the position in relation to hand hygiene. There is no doubt that good hand hygiene is absolutely critical. I can tell the noble Viscount, Lord Bridgeman, that the National Patient Safety Agency has set up a project on hand hygiene, developing guidance for trusts on ways on improve compliance. although every trust should have its own policy. We are presently identifying pilot sites in order to gather even more information to feed back on better practice.
	As the noble Baroness, Lady Masham, pointed out, other strategies must be employed, such as access to alcohol rubs. Such procedures are very simple, but effective. I take the points made by the noble Earl, Lord Howe, in his long list of what can be done. Most important, however, is that all the information is brought together. Further work is being done to produce a national infection control manual which will bring together all the different elements of information and guidance. It will be on the Web to access.
	On the issue of the over-prescription of antibiotics, I can tell all noble Lords who referred to this that our campaign on antibiotic prescribing and overuse is still in place. While I would not like to say that it has had a direct impact, we have seen a drop in GP prescribing. However, I am sure that my noble friend Lord Ashley will appreciate that the campaign is up and running strongly.
	Much emphasis has been placed on research during this debate. I could not agree more that we need more systematic research. We are spending around £4.7 million on research; of that, we have just put out a new call of £2.5 million for new proposals. We have commissioned, for example, new research on antimicrobial resistance. Furthermore, we have a commissioned health technology assessment review of isolation screening policies which is to be published shortly. Southampton University Hospital Trust is looking at ways of developing a rapid test for MRSA. I did not know about the Strathclyde University research mentioned by the noble Earl. It sounds extremely interesting and we would like to follow it up. The ozone research mentioned by the noble Lord, Lord Colwyn, is particularly interesting. It is not lateral thinking but I am sure that the department would want to look at the points raised by the noble Lord.
	Turning to the points raised in regard to the pharmaceutical industry, we want to extend our dialogue across the industry. Although that is probably not enough for my noble friend Lord Ashley, it is evidence of our concern to work with the industry. I take the point made by the noble Lord, Lord Chan, that hospital pharmacists have a key role to play in helping to reduce over-prescribing in hospitals.
	Along with other noble Lords, while I take the point that there is no apparent correlation between increases in the rate of MRSA infection and poor levels of cleanliness, common sense would suggest that there could be a link. We intend to examine the existing evidence in more detail.
	We are now seeing real changes in hospital procedures, being driven not least by the modern matrons and ward housekeepers. It is their job to ensure that someone is told to dust under the beds. Indeed, the public perception now is that hospital cleanliness is improving.
	I hope that, with better knowledge, better measurement and better enforcement, along with collective and coherent action, we shall make a difference in seeking to reduce the incidence of this appalling infection.

House adjourned at nineteen minutes past nine o'clock.